Surgery Section DOI : 10.7860/JCDR/2018/32633.12282
Year : 2018 | Month : Nov | Volume : 12 | Issue : 11 Page : PJ01 - PJ01

Ball in Right Atrium Cavity: What is your Diagnosis?

Ansul Kumar1, Arpita Rai2

1 Assistant Professor, Department of Cardiothoracic and Vascular Surgery, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.
2 Assistant Professor, Department of Oral Medicine and Radiology, Jamia Millia Islamia, New Delhi, Delhi, India.


NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR: Dr. Ansul Kumar, Assistant Professor, Department of Cardiothoracic and Vascular Surgery, RIMS, Ranchi-834009, Jharkhand, India.
E-mail: docansul@gmail.com
Abstract

How to cite this article

Ansul Kumar, Arpita Rai, .BALL IN RIGHT ATRIUM CAVITY: WHAT IS YOUR DIAGNOSIS?.Journal of Clinical and Diagnostic Research [serial online]2018 Nov[cited:2019 May 23] 11 PJ01 - PJ01
 Available from
http://www.jcdr.net//back_issues.asp

A 28-year-old female presented with dyspnea on exertion for the last three years. Clinical examination showed presence of systolic murmur over 2nd intercostal space radiating to ipsilateral axilla. Trans-Oesophageal Echocardiography (TTE) revealed enlarged Right Atrium (RA), Right Ventricle (RV) and Left Atrium (LA). TTE also showed presentation of a ball in the right atrial cavity [Table/Fig-1], along with normal bilateral ventricular function and left to right shunt [Table/Fig-2].

Transesophageal Echocardiography (TEE) showing ball in RA.

RA: Right atrium, RSOV: Ruptures sinus of valsalva

TEE showing left to right shunt from right coronary sinus to right atrium.

Cardiac catheterization study confirmed Rupture Sinus of Valsalva (RSOV) arising from right coronary sinus and projecting to right atrium with oxygen step-up in RA. Intraoperatively the enlarged, globular mass seen in RA [Table/Fig-3] was plicated and Poly Tetra Flouro Ethylene (PTFE) patch closure of aortic end of the sinus was performed.

Intraoperative photograph showing a ball in the right atrium.

Ruptured sinus of valsalva aneurysm, a rare but well-recognised clinical entity, is invariably a form of left-to-right shunt due to rupture into right-sided chambers. This condition is found more commonly in Asians than western population [1]. Recently, Xin-Jin L et al., have proposed a modified Sakakibara classification system for RSOV aneurysm according to the site of rupture [2]. Surgical closure is the backbone of therapy for RSOV and has operative mortality of <5 % [3]. Transcatheter closure has been proposed as a safe and effective alternative to traditional surgical correction in selected cases [4,5].

References

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[2]Xin-Jin L, Xuan L, Bo P, Hong-Wei G, Wei W, Shou-Jun L, Sheng-Shou H, Modified sakakibara classification system for ruptured sinus of valsalva aneurysm J Thorac Cardiovasc Surg 2013 146(4):874-78.

[3]van Son JA, Danielson GK, Schaff HV, Orszulak TA, Edwards WD, Seward JB, Long-term outcome of surgical repair of ruptured sinus of Valsalva aneurysm Circulation 1994 90(5 Pt 2):II20-29.

[4]Kerkar PG, Ruptured sinus of Valsalva aneurysm: Yet another hole to plug! Annals of Pediatric Cardiology 2009 2(1):83-84.

[5]Zhong L, Tong SF, Zhang Q, Zhang ZH, Yao Q, Li YH, Clinical efficacy and safety of transcatheter closure of ruptured sinus of Valsalva aneurysm Catheter Cardiovasc Interv 2014 84:1184-89.