Case Report| Volume 25, ISSUE 5, P292-296, May 2022

Ruptured sinus of Valsalva aneurysm due to Infective Endocarditis managed by device closure - a case report

Published:December 08, 2021DOI:


      Ruptured sinus of Valsalva aneurysm (RSOV) is an uncommon cause of high output heart failure. RSOV most commonly opens into the right ventricle followed by the right atrium and non-coronary cusp involvement is relatively uncommon. Infective endocarditis (IE) is a rare cause of RSOV. We report an interesting clinical scenario of IE causing RSOV managed by device closure. A 16-year-old male patient presented to the emergency department with acute chest pain, fever, and engorged neck veins. On cardiorespiratory system examination he had features of left ventricular failure. Blood culture revealed growth of Staphylococcus aureus. Echocardiography and computed tomography aortography confirmed the diagnosis of 9 mm type IV RSOV (non-coronary cusp to right atrium) with vegetation (5 × 6 mm). The patient refused surgery. When there was no apparent visible vegetation after 6 weeks of antibiotic therapy, we proceeded with 12-mm Amplatzer duct occluder II closure of the anatomical defect. Monthly follow up has been uneventful for 6 months. As per our knowledge this is the first ever reported case of documented definitive IE by S. aureus causing Sakakibara and Konno ruptured Type IV RSOV that has been managed successfully by device closure.
      <Learning objective: Ruptured sinus of Valsalva aneurysm (RSOV) secondary to native valve infective endocarditis (IE) can occur in apparently healthy young individuals with no predisposing factor. Device closure is a good therapeutic option in selective cases of RSOV secondary to native valve IE. Further research is needed to understand the role of device closure in such clinical settings as an alternative to surgical options.>


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        • Vautrin E
        • Barone-Rochette G
        • Philippe J
        Rupture of right sinus of valsalva into right atrium: Ultrasound, magnetic resonance, angiography and surgical imaging.
        Arch Cardiovasc Dis. 2008; 101: 501-502
        • Vereckei A
        • Vándor L
        • Halász J
        • Karádi I
        • Lengyel M.
        Infective endocarditis resulting in rupture of sinus of Valsalva with a rupture site communicating with both the right atrium and right ventricle.
        J Am Soc Echocardiogr. 2004; 17: 995-997
        • Mahimarangaiah J
        • Chandra S
        • Subramanian A
        • Srinivasa KH
        • Usha MK
        • Manjunath CN.
        Transcatheter closure of ruptured sinus of Valsalva: Different techniques and mid-term follow-up.
        Catheter Cardiovasc Interv. 2016; 87: 516-522
        • Sakakibara S
        • Konno S.
        Congenital aneurysm of the sinus of Valsalva anatomy and classification.
        Am Heart J. 1962; 63: 405-424
        • Habib G
        • Lancellotti P
        • Antunes MJ
        • Bongiorni MG
        • Casalta JP
        • Del Zotti F
        • Dulgheru R
        • G El Khoury
        • Erba PA
        • Iung B
        • Miro JM
        • Mulder BJ
        • Plonska-Gosciniak E
        • Price S
        • Roos-Hesselink J
        • et al.
        ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM).
        Eur Heart J. 2015; 36 (2015): 3075-3128
        • Diwakar A
        • Patnaik SS
        • Hiremath CS
        • Chalam KS
        • Dash P
        Rupture of sinus of Valsalva – a 15 years single institutional retrospective review: Preoperative heart failure has an impact on post operative outcome?.
        Ann Card Anaesth. 2019; 22: 24-29
        • Chu SH
        • Hung CR
        • How SS
        • Chang H
        • Wang SS
        • Tsai CH
        • Liau CS
        • Tseng CD
        • Tseng YZ
        • Lee YT
        • Lien WP
        • Lue HC
        • Lin TY
        Ruptured aneurysms of the sinus of Valsalva in Oriental patients.
        J Thorac Cardiovasc Surg. 1990; 99: 288-298
        • Missault L
        • Callens B
        • Taeymans Y.
        Echocardiography of sinus of valsalva aneurysm with rupture into the right atrium.
        Int J Cardiol. 1995; 47: 269-272
        • Baddour LM
        • Wilson WR
        • Bayer AS
        • Fowler Jr, VG
        • Tleyjeh IM
        • Rybak MJ
        • Barsic B
        • Lockhart PB
        • Gewitz MH
        • Levison ME
        • Bolger AF
        • Steckelberg JM
        • Baltimore RS
        • Fink AM
        • O'Gara P
        • et al.
        Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association.
        Circulation. 2015; 132: 1435-1486
        • Li SJ
        • Sexton DJ
        • Mick N
        • Nettles R
        • Fowler Jr, VG
        • Ryan T
        • Bashore T
        • Corey GR.
        Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis.
        Clin Infect Dis. 2000; 30: 633-638