sinus of Valsalva aneurysm....

Ruptured left sinus of Valsalva aneurysm into the left atrium in a dog*

S.M. Fultz a, H.B. Kellihan a,*, P. Nagpal b

Background
The study describes a rare case of a ruptured sinus of Valsalva aneurysm (SOVA) leading to a fistulous connection with the left atrium in a dog. This condition, uncommon in veterinary medicine, involves a structural cardiac defect that can result from congenital or acquired factors. The report highlights the diagnostic value of advanced imaging techniques, such as cardiac-gated computed tomography angiography (CTA), in identifying complex cardiac anomalies.

Methods
The subject was a five-year-old spayed female labradoodle initially diagnosed with immune-mediated thrombocytopenia in 2016. The dog presented with a new systolic heart murmur, which prompted further cardiac evaluation. Over six years, the patient underwent repeated echocardiography and radiography, culminating in cardiac-gated CTA to elucidate the anomaly. Echocardiographic findings included a continuous flow fistula between the aorta and left atrium. The CTA confirmed a ruptured aneurysm of the left sinus of Valsalva as the source.

Results
The echocardiograms showed severe left ventricular dilation, trace aortic regurgitation, and mild mitral regurgitation without significant left atrial enlargement. The fistulous connection remained unchanged over six years, and the patient remained clinically stable. The CTA provided detailed three-dimensional imaging of the aneurysm and its fistulous connection, confirming the suspected diagnosis.

Limitations
The case study focuses on a single patient, limiting the generalizability of findings. The exact etiology of the SOVA rupture and subsequent fistula formation remained unclear, though suspected to be related to endocarditis or trauma. Additionally, the absence of significant progression in clinical signs may not apply to other cases.

Conclusions
This report emphasizes the potential for long-term clinical stability in dogs with ruptured SOVA and associated fistulas when managed appropriately. Advanced imaging techniques, particularly CTA, are invaluable for accurate diagnosis and management planning. This case contributes to the limited veterinary literature on SOVA and its implications in non-human species.

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