Perforation of sinus Valsalva 10 years after repair of ventricular septal defect.

摘要

A 60-year-old woman who underwent ventricular septal defect (VSD) closure, mitral valve repair, and tricuspid annuloplasty 10 years earlier, presented with congestive heart failure. Her previous postoperative echocardiogram demonstrated a residual VSD leak and moderate mitral regurgitation. Transesophageal echocardiography (Figure 1) showed moderate mitral regurgitation, severe tricuspid regurgitation, a large atrial septal defect, and a fistulous communication from the sinus of Valsalva to the right ventricle, which was confirmed by multi-slice computed tomography (Figure 2). Surgery revealed a prolapsed right coronary cusp with a 3-mm perforation at the lower end of the prolapsed leaflet, adhering to the edge of the VSD patch. The fistula was closed with autologous right coronary valvular leaflet, and concomitant aortic and mitral valve replacement was performed with repeat tricuspid annuloplasty and patch closure of the atrial septal defect that was caused by dehiscence of the previous interatrial septum atriotomy.