Author + information
- Received April 21, 2015
- Revision received May 29, 2015
- Accepted June 19, 2015
- Published online November 1, 2015.
- Robert Sabiniewicz, MD, PhD∗,
- Jarosław Meyer-Szary, MD∗∗ (, )
- Piotr Siondalski, MD, PhD†,
- Magdalena Kołaczkowska, MD, PhD† and
- Rafał Gałąska, MD, PhD‡
- ∗Department of Pediatric Cardiology and Congenital Heart Defects, Medical University of Gdansk, Gdańsk, Poland
- †Department of Cardiac & Vascular Surgery, Medical University of Gdansk, Gdańsk, Poland
- ‡Department of Cardiology, Medical University of Gdansk, Gdańsk, Poland
- ↵∗Reprint requests and correspondence:
Dr. Jarosław Meyer-Szary, Department of Pediatric Cardiology and Congenital Heart Diseases, Medical University of Gdansk, M. Skłodowskiej-Curie 3a, 80-210 Gdansk, Poland.
A 35-year-old woman with no past medical history presented after experiencing 6 months of progressive fatigue (New York Heart Association functional class II). Diagnostic 2-dimensional echocardiography (2DE) revealed a 7-mm hemodynamically significant noncoronary ruptured sinus of Valsalva aneurysm into the right atrium. Work-up revealed a normal coagulation profile and no comorbidities. Percutaneous closure of the aneurysm was performed uneventfully via femoral access using the self-expandable ADO 9-PDA-004 (AGA Medical Corporation, Golden Valley, Minnesota) (4/6/10 mm). The aortic retention disc was deployed with full contact with minimal residual shunt post-procedure (Figures 1A and 1B, Online Video 1). The patient took aspirin for 6 months. Follow-up 2DE at 0, 1, 3, 6, and 12 months documented proper implant placement without residual shunt or thrombosis.
Nearly 2 years later, the patient underwent popliteal endarterectomy for acute thromboembolism. Evaluation with 2DE revealed a massive (13 × 16 × 37 mm) thrombus originating at the noncoronary sinus of Valsalva (Figures 2A to 2D, Online Video 2). No aortic regurgitation, aortic stenosis, or residual shunt at the site of the device was detected. The thrombus and the device were surgically extracted, and the noncoronary sinus of Valsalva was reconstructed uneventfully, with no shunt or aortic valve dysfunction on follow-up 2DE. Pathological evaluation of the extracted specimen (Figures 1C to 1D, Figures 2D to 2H) revealed proper endothelialization of the device on the right-atrial side and a thrombus with a well-organized fibrous nucleus originating at the aortic disc of the implant, consistent with a chronic process lasting approximately 3 to 6 months. A hypercoagulable state is suspected.
All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 21, 2015.
- Revision received May 29, 2015.
- Accepted June 19, 2015.
- American College of Cardiology Foundation