Ruptured aneurysm of the sinus of Valsalva into the left ventricle: a case report and review of the literature

This report describes a case of right coronary sinus of Valsalva aneurysm which ruptured into the left ventricle. The diagnosis was made with two-dimensional transthoracic echocardiography which showed an abnormal structure extending from the aortic root into the left ventricle adjacent to the interventricular septum. Subsequent examinations with transesophageal echocardiography and aortic root angiography and surgical findings confirmed the diagnosis of transthoracic echocardiography. The patient underwent aortic valve replacement. At follow-up 12 months later, the patient was without symptoms and repeated echocardiographic examinations showed no recurrence.     

Rupture of a sinus of Valsalva aneurysm into the right ventricle. A case report in the cardiology clinic at the University Hospital Center of Dakar]

Human cytolytic T lymphocytes specific for autologous Burkitt's lymphoma express the gamma, delta T cell receptor and recognize immunoglobulin idiotype in an MHC-unrestricted manner. Antibodies against a member of the heat shock protein 70 family inhibit this specific cytotoxicity, implicating these molecules in tumor recognition and antigen presentation. Such data is relevant to the design of novel immunotherapies for cancer and provides new insights into target recognition by gamma, delta T cells.     

Communication between the left ventricle and the right atrium in infectious endocarditis. Diagnosis using Doppler-echocardiography

OBJECTIVE: To examine regional distribution of blood flow in the brain of horses at rest and during exercise. ANIMALS: 9 clinically normal horses. PROCEDURE: Regional brain blood flow was measured using radionuclide-labeled 15-microns-diameter microspheres injected into the left ventricle, while reference blood samples were obtained from the aorta. RESULTS: At rest, cerebral cortex and caudate nuclei received significantly higher blood flow, compared with cerebral white matter. A similar perfusion heterogeneity existed in the cerebellum. In the brain stem, a gradual tapering of blood flow from thalamus-hypothalamus towards medulla was observed in standing horses. Progressive significant increases in heart rate and in aortic and right atrial pressures occurred during exercise at 8 and 13 m/s, and horses developed significant arterial hypoxemia and hypercapnia. Cerebral and cerebellar gray- to white-matter perfusion heterogeneity was maintained during exercise, indicating differential metabolic O2 needs. Despite arterial hypoxemia, hypercapnia, and hypertension, exercise did not result in significant changes in blood flow to the cerebral cortex and caudate nuclei whereas, in cerebral white matter, a significant decrease in blood flow was observed. In all cerebral tissues, vascular resistance increased during exercise, indicating autoregulation of cerebral blood flow. In the cerebellar cortex, blood flow increased significantly with strenuous exercise as vasodilation occurred. Vascular resistance in cerebellar white matter increased during exercise at 13 m/s. Blood flow in the medulla, pons, midbrain, and thalamus-hypothalamus was not significantly altered during exercise from that at rest. CONCLUSION: Despite arterial hypoxemia, hypercapnia, and hypertension, autoregulation of cerebral and cerebellar blood flow is maintained in horses during exercise.     

Repair of mitral valve and subaortic mycotic aneurysm in a child with endocarditis

Endocarditis requiring surgical intervention in children is uncommon. Individualized operative therapy must be fashioned to the particular pathology of each case. In this case we describe mitral anterior leaflet homograft patch augmentation valvuloplasty, subaortic homograft patch closure of a large mycotic aneurysm, and homograft aortic root replacement in a 3-year-old patient with endocarditis after remote repair of complete atrioventricular canal.     

Open heart surgery in a Jehovah's Witness boy--a case report of successful management of aortic regurgatation and aneurysm of sinus Valsalva due to infective endocarditis

Jehovah's Witness who require operation represent a challenge to the physician because of the patients' refusal to accept blood transfusion. We report an 8-year-old male of Jehovah's Witness who underwent a surgical treatment of infective endocarditis. He was transferred to our hospital because of high fever and heart murmur. Echocardiogram revealed a developing vegetation of aortic cusps and an aneurysmal change of the non-coronary sinus Valsalva. On admission he was complicated by anemia, purulent meningitis and suppurative arthritis of left knee. There were no signs of cardiac failure. Erythropoietin (6000 U thrice weekly) and iron (60 mg daily) were given for 11 weeks prior to surgery, raising the hemoglobin level from 9.2 g/dl to 18.4 g/dl. Aortic valve replacement and plasty of the sinus Valsalva were then performed. Intraoperatively hemoglobin concentration dropped to 10.3 g/dl and it raised to 15 g/dl postoperatively. We also used Cell-Saver to reduce blood loss. The patient made an uncomplicated recovery. Erythropoietin therapy contributed substantially to the successful outcome of this case.     

An autopsy case of the sinus of Valsalva aneurysm involved with tuberculous inflammation, leading to complete heart block

A case is presented of unruptured aneurysm of the non coronary sinus of Valsalva, causing involvement of A-V node and right coronary artery compression. The patient was a 68 year-old woman with a complaint of general fatigue. Electrocardiogram showed complete A-V block. Computed tomography showed an aneurysm of the non coronary sinus of Valsalva. A temporary pacemaker was implanted, but the patient developed respiratory failure and heart failure and died. At autopsy, macroscopically disseminated tuberculosis was noted in both lungs and kidneys. Microscopically a tuberculous inflammatory lesion extending into the A-V node was found. We report this rare case with some consideration of the literature.     

A large right coronary artery-left ventricle fistula with mild volume overload on the left ventricle owing to its capacitive action--pulsed Doppler and cineangiographic analyses in a patient

A 54-year-old woman was admitted to our hospital because of a heart murmur without subjective symptoms. Angiography disclosed an enlarged right coronary artery and flow drainage into the left ventricle, ie, a large right coronary artery-left ventricle fistula. Analysis of pulsed Doppler studies and cineangiograms indicated considerable capacitance of this fistula owing to Windkessel action, which attenuated volume overload on the left ventricle. The features in this case suggest that evaluation of fistula hemodynamics is important in determining the overload on the ventricle through the fistula.     

Hemodynamic changes in acute respiratory insufficiency: the role of the right ventricle

Acute respiratory failure, particularly if associated with sepsis, results in diffuse changes in pulmonary vascular geometry and the afterload characteristics against which the right ventricle must perform. Therapy in these patients frequently requires replacement of intravascular volume which, if pulmonary vascular resistance is abnormally elevated, may cause a substantial enlargement in right ventricular (RV) end-diastolic volume. The low compliance characteristics of the RV invalidate the use of filling pressure (CVP) as a guide to RV size. We have examined RV volume in critically ill patients by means of the gated 99TAc scan and noted a substantial increase in RV volume despite filling pressure in the upper normal range. This enlargement appears to encroach upon LV function because the ejection fraction of the LV remained high despite elevation of pulmonary capillary wedge pressure (PCWP). Older patients with "silent" right coronary artery disease may become hemodynamically limited during therapy for acute respiratory failure and sepsis due to RV enlargement, increased wall tension and RV ischemia, a condition not readily diagnosed at the bedside with the usual monitoring techniques.     

Infectious endocarditis, risk factors, prevention. Research group for infectious endocarditis and jury of the consensus conference

Infective endocarditis, resulting from deposition of circulating microorganisms during a period of bacteremia on damaged endothelial heart valves, remains a serious disease. Its overall incidence did not decline in recent years, 24 cases/year/million inhabitants, in France. This can be explained by a modification of the type of underlying cardiac conditions with regression of rheumatic fever and increase of degenerative heart diseases, prosthetic valves and mitral valve prolapse. The risk of bacterial seeding on a damaged valve remains difficult to evaluate, the highest risk being for patients with prosthetic valve, previous infective endocarditis and cyanotic congenital heart disease. A case-control study, done in 1991, confirmed that procedures are risk factors for infective endocarditis and that the multiplicity of procedures increases the risk. A French consensus conference on the prophylaxis of infective endocarditis has updated the recommendations for antibiotic prophylaxis. Two groups of cardiac patients were identified, based on the incidence and the severity of endocarditis occurring in patients with these conditions, 1) patients considered at risk which require specific prophylaxis, and 2) patients considered non at risk which do not require antibiotic prophylaxis. Procedures which require antibiotic prophylaxis are dental procedures and specific gastrointestinal and urologic procedures. As complex protocols are associated with poor compliance by practitioners and patients, the jury has aimed for simplicity and feasibility.     

Bilateral cerebral mycotic aneurysm in a child. Report of a case and review of the literature]

Bronchial provocation tests by "occupational" exposure to flour provoked dual asthmatic reactions accompanied by rhinitis in two atopic bakers engaged in the manufacture of bread and pies. Ingestion tests with uncooked flour produced no reactions. Skin prick tests with aqueous extracts of flour produced positive immediate reactions in both bakers, and negative reactions in nine of ten atopic asthmatic control subjects with no occupational exposure to flour. Intracutaneous tests, performed in one precipitin negative baker, gave dual responses. Precipitating antibodies to an aqueous extract of flour were found in the unconcentrated serum of the other baker, and not in ten control subjects.     

Concomitant infarction of the right ventricle in patients with acute transmural myocardial infarction (author's transl)

In 56 patients with acute transmural myocardial infarction hemodynamic parameters were studied. 21 patients proved to suffer from anterior infarction and 35 patients an inferior infarction. By clinical as well as by hemodynamic findings 10 patients out of the group of the 35 patients with inferior infarction were suspect of having a concomitant infarction of the right ventricle. As it is known from literature and documented by the present results this is not a rarity. Failure of the right ventricle is the main cause of death in these patients.     

Aorto-left ventricular tunnel with origin in the left sinus of Valsalva: a rare cause of congenital aortic insufficiency

The effects of intravenous cisplatin (CDDP) administration on the generation of lymphokine-activated killer (LAK) activity in peripheral blood mononuclear (PBM) cells were investigated in cancer patients. The ability of PBM to generate LAK activity was significantly augmented 3, 5 and 7 days after a single dose, 50 mg m-2, of CDDP injection when compared to that before injection. NK activity of PBM was not altered. The distribution of lymphocyte subsets exhibited no significant change following CDDP injection, except CD2+ cells. However, the ability of monocytes in PBM to produce TNF-alpha was significantly enhanced 5 days after the drug administration, although IL-1-alpha and IL-1-beta production was not augmented.