Ruptured Sinus of Valsalva Aneurysm and Coarctation of Aorta in a Woman at Early Postpartum Period

Coarctation of aorta and sinus of Valsalva aneurysm are frequently missed congenital cardiac defects that their diagnosis might be delayed. To our knowledge, coincidence of these cardiac defects is unusual and has not been reported in the literature before. Here, we present a patient with coarctation of aorta and ruptured noncoronary sinus of Valsalva aneurysm leading to aorto-right atrial fistula in the early postpartum period and our management of this unusual case. 1. Introduction Coarctation of aorta (CoA) is a relatively common abnormality that occurs in approximately 6–8% of patients with congenital heart disease [1]. The diagnosis of coarctation of the aorta may be missed unless an index of suspicion is maintained, and diagnosis is often delayed until the patient develops symptoms. Early diagnosis is possible in the first years of life in symptomatic patients whereas it might be delayed in asymptomatic patients. Untreated CoA might cause severe hypertension, intracranial bleeding, aortic aneurysm formation, and even aortic rupture. Additionally, infective endocarditis, early atherosclerosis due to intimal proliferation and degeneration in coronary arteries may be seen as well. Sinus of Valsalva aneurysm (SVA) is usually referred to as a rare congenital anomaly. Its origin may be either acquired or congenital. A congenital SVA is usually clinically silent but may vary from a mild, asymptomatic dilatation to symptomatic presentations related to the compression of adjacent structures or intracardiac shunting caused by rupture of the SVA into the right side of the heart. Approximately 65–85% of SVAs originate from the right sinus of Valsalva and the most common complication is rupture into the atrium or ventricle. However, the potential risk of rupture, cardiac failure, stroke, and sudden death has led authors to consider surgical repair of unruptured aneurysms even if they are asymptomatic or incidentally detected, reporting a generally low early surgical and long term mortality [2]. In this case, we report surgical management of a patient in the early postpartum period with a noncoronary SVA complicated with a aorta-right atrial fistula and accompanying asymptomatic and untreated CoA. 2. Case History A 19-year-old patient without previous history of cardiovascular disease was admitted to our hospital with chest pain and dyspnea. She had delivered a premature baby one month before her admission. Physical examination revealed 3/6 continuous systolic murmur in aortic valve region. Lower extremity pulses were absent. Blood pressure was 150/60？mm？Hg on