Ruptured Sinus of Valsalva: A Life Threatening Complication in an Uncomplicated Vaginal Delivery Successfully Managed by Transcatheter Device Closure
Pradeep Jain *
Department of Pediatric Cardiology, Superspeciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh-482002, India.
Abhinav Agrawal
Department of Pediatrics, Era Medical College, Lucknow, Uttar Pradesh-226001, India.
Shipra Dwivedi
Department of Gynecology & Obstetrics, Max Hospital, Lucknow, Uttar Pradesh-226001, India.
Nimish Rai
Department of CTVS, Superspeciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh-482002, India.
*Author to whom correspondence should be addressed.
Abstract
Background: Rupture of a sinus of Valsalva aneurysm is uncommon and may be associated with acute haemodynamic deterioration. The cardiovascular changes of labour and delivery may contribute to the rupture of an undiagnosed aneurysm. This report describes a postpartum presentation after an uncomplicated vaginal delivery and subsequent transcatheter management.
Case presentation: A 28-year-old multiparous woman developed sudden chest pain and progressive dyspnoea immediately after an uncomplicated vaginal delivery. Examination identified tachycardia, bounding peripheral pulses, raised jugular venous pressure and a continuous murmur. Transthoracic echocardiography demonstrated a 7-mm rupture originating from the right coronary sinus and communicating with the right ventricular outflow tract, producing continuous left-to-right shunting. Aortography confirmed the anatomical findings. The patient initially received diuretics and standard heart failure therapy; however, her symptoms persisted. On the eighth postpartum day, transcatheter closure was undertaken using a 14/12 mm Cocoon duct occluder under fluoroscopic and echocardiographic guidance. Completion angiography showed closure without residual shunting or new aortic regurgitation, with preserved right coronary artery flow. Symptoms resolved after the procedure, and she was discharged on the third post-procedure day. She remained asymptomatic at three-month follow-up.
Conclusion: This case illustrates the importance of considering ruptured sinus of Valsalva aneurysm in postpartum heart failure when clinical examination suggests an abnormal intracardiac shunt. Transcatheter closure was feasible in this patient after stabilisation and assessment of anatomical suitability.
Keywords: Ruptured sinus of valsalva aneurysm, pregnancy, vaginal delivery, device closure, congenital heart disease