A Rare Case Report of Ruptured Sinus of Valsalva in Pregnancy: Role of Transesophageal Echocardiography

摘要

Ruptured sinus of Valsalva (RSOV) is a rare but potentially fatal condition and is usually associated with congenital conditions like ventricular septal defect (VSD), aortic insufficiency, and bicuspid aortic valve. Ruptured sin us of Valsalva is rare in pregnancy and if present, causes additional strain on the already stretched hemodynamics of a pregnant female. Very few cases of an RSOV in pregnancy have been reported. We describe a case of RSOV during pregnancy. A 26-year-old woman presented with shortness of breath on exertion, chest pain, and palpitations at the 20th week of gestation. She had a spontaneous conception which was confirmed with ultrasound in the first trimester. Her trimester history was uneventful; she received folic acid in the first trimester and oral iron and calcium supplements and also tetanus toxoid (TT) immunization. She had quickening at the 5th month of gestation and was asymptomatic without any medications until the end of the second trimester. She presented to the hospital at the end of the second trimester of pregnancy and on examination, her heart rate was 110/minute, blood pressure 96/66, SpO_2 99%, respiratory rate 24/minute, and NYHA grade III. She had a pan systolic murmur on auscultation but no crepts in lung fields. 12-lead electrocardiography (ECG) showed normal sinus rhythm at a rate of 110 bpm with no evidence of right-heart strain. Sonography revealed a healthy fetus with adequate size for gestational age and no evidence of malformations.