Bicuspid aortic valve with infective endocarditis and ruptured right sinus of valsalva aneurysm to left ventricular outflow tract: A case report

Tóm tắt

Background: Sinus of Valsalva (SOV) aneurysm is a rare disease wherein clinical manifestations vary widely and often related to aneurysm rupture or mass effect on adjacent cardiac structures. It may be congenital or acquired which are mostly associated with infectious etiologies ( e.g. tuberculosis and bacterial endocarditis). It has a worldwide incidence rate of 0.09%. There is a male predilection and more common among Asian population, however, with unknown incidence, morbidity and mortality rates in the local setting.

Methods: A case of a 59-year-old male, Filipino, consulted with a three-week history of chills and body malaise. On the day of admission, patient experienced chest pain and low grade fever. Initial examinations revealed positive blood cultures and bicuspid aortic valve on 2D echocardiogram. On further work up, CT coronary revealed a ruptured right sinus of Valsalva (SOV) aneurysm. Meticulous monitoring and immediate treatment of infective endocarditis was employed as a possible cause of ruptured SOV aneurysm, the patient was clinically stable with no heart failure symptoms.

Results: Diagnosis of infective endocarditis warrants a complete and thorough examination in order to properly manage its course and prevent its deleterious complications. The patient was managed successfully with medical treatment, but refused surgical intervention despite in-depth patient counselling. Ruptured SOV aneurysm will eventually go into decompensation later on hence, timely surgical intervention is required. Advisable earliest time of surgery is when infection has resolved. Due to the rarity of the this disease and majority of reported cases have either undergone definitive surgical intervention or underwent into decompensation, at the time of writing there is currently no data available on how these patient should be monitored if definitive cardiac surgery was not employed.

This patient was managed successfully with medical treatment. He was advised surveillance monitoring and imaging with 2D echocardiogram every three months.

Conclusion: Although rare, asymptomatic patients with ruptured SOV aneurysm may still be encountered. Close follow-up, monitoring of symptoms and surveillance imaging should be done for timely surgical intervention.