Congenital aneurysm of the sinus of Valsalva. Anatomy and classification.

The three slight dilatations of the aorta immediately above the corresponding valve cusps, known as the aortic sinuses of Valsalva, are almost entirely intracardiac and lie near important parts of the heart (Fig. 1). Aneurysms arising from these sinuses may extend into the cardiac chambers and encroach upon the pulmonary valve, the atrioventricular valves, the conducting bundle, or the pulmonary or coronary arteries, or may lead to aortic regurgitation by deforming the aortic ring. They may rupture into one of the cardiac chambers, the pulmonary artery, or the pericardium, and sometimes communicate from birth with a cardiac chamber or the pulmonary artery. To these various complications such aneurysms owe much of their interest. Aneurysms confined to the aortic sinuses are uncommon; Smith (1914) noted that in 8138 necropsies only 7 were found and, in all, only 20 cases were confirmed at necropsy prior to 1914. These aneurysms may be due to any of the usual causes, but those ofcongenital origin are ofparticular interest. The first recorded case of this type appears to be that of Thurnam (1840) and when Abbott (1936) collected her 1000 cases of congenital heart disease she was able to find only 12 congenital aortic sinus aneurysms recorded (Bauer & Astbury, 1944). Our objects in this paper are to describe four new cases, which present certain features of interest, and to review the available clinical and pathological material particularly so far as it illustrates the pathological differences between the acquired and congenital types of aneurysm or aids the clinical diagnosis of congenital aneurysms. Some preliminary discussion of the nomenclature of the aortic sinuses and of the topography of the aortic root is desirable to clarify the anatomical features of the cases to be described. 325 NOMENCLATURE OF TmE AORTIC SINusEs The many ways of naming the aortic cusps and their sinuses are so confusing that it is often difficult to identify the sinus described. In Table I we have enumerated five methods of nomenclature and in Fig. 2 have indicated the sinus to which each name refers. The standard nomenclatures [Old Terminology; Basle Anatomical Nomenclature, 1895 (B.N.A.); Birmingham Revision, 1933 (B.R.)] have assumed that one aortic sinus lies anterior and two posterior, and always placed in an anterior position the sinus from which the right coronary artery arises, but Walmsley (1929) has pointed out that sometimes two aortic sinuses lie anterior, and one posterior (Fig. 2); he suggested that sinuses related to the coronary arteries should be named right and left coronary sinuses, the third sinus being called the non-coronary sinus. This nomenclature is easy to understand and allows the sinuses to be named when the heart has been removed from the body and the sinuses exposed by opening the aorta; we have therefore adopted it in this paper.

https://heart.bmj.com/content/heartjnl/11/4/325.full.pdf

Aortic sinus aneurysms

An unruptured congenital sinus of Valsalva aneurysm (behind the right aortic valve cusp) is described as an incidental necropsy finding in an 82 year old man. Review of previous reports on aneurysms involving only one of the three aortic sinuses discloses that few cases have been described, and that these lesions are rarely diagnosed during life. It is probable, however, that unruptured aortic sinus aneurysm (involving only one sinus) is more common than previous reports indicate, but that, among patients with congenital sinus aneurysm, rupture is likely to occur.

Unruptured sinus of Valsalva aneurysm.

Congenital aneurysms of sinus of Valsalva A clinical study

https://www.annalsthoracicsurgery.org/article/S0003-4975(10)64149-5/pdf

Congenital Left Aortic Sinus-Left Ventricle Fistula and Review of Aortocardiac Fistulas

Disturbances of conduction in the heart may be purely functional, when for example demands are made on the conduction path very early in diastole as seen in blocked and aberrantly conducted auricular extrasystoles (Scherf and Boyd, 1940), or when too many stimuli are presented for conduction within a short time as with the incomplete A-V block that always exists in auricular fibrillation. Conduction disturbances may also be due to vagal inhibition. They may occur transiently after pneumonia and influenza, and are well known in diphtheria; recently Neubauer (1942) found many examples of partial and complete block in 100 cases of diphtheria. Over-digitalization may through poisoning of the A-V node lead to prolongation of conduction time, partial, or complete block. A permanent block can be established through coronary sclerosis, coronary thrombosis, rheumatic heart disease, syphilitic gumma, and more rarely through diphtheria, tuberculosis, and carcinoma affecting the A-V node or bundle directly. Congenital complete heart block is also known, and a few cases were found by Yater (1929), Aitken (1932), Campbell and Suzman (1934), and Currie (1940). The exceptional event of heart block as a result of direct trauma to the chest wall is described by Coffen (1930), Walker (1933), and White (1937). The following is the report of a case in which complete heart block was associated with an intracardiac aneurysm and aortic stenosis.

https://heart.bmj.com/content/heartjnl/6/2/61.full.pdf

Paul F. Duras

Papers

Heart block with aneurysm of the aortic sinus.