Preliminary experience using transthoracic echocardiography guiding percutaneous closure of ruptured right sinus of Valsalva aneurysm

Background In the 21st century, minimally invasive treatment is one of the main developmental directions of medicalsciences. It is well known that the echocardiography plays an important role during interventional treatments of somestructural heart diseases. Because the ruptured right sinus of the Valsalva aneurysm (RRSVA) is a rare disease, therewere few reports about percutaneous catheter closure of RRSVA. This study aimed to sum up our experience withtransthoracic echocardiography (TTE) during percutaneous catheter closure of RRSVA.Methods Five RRSVA cases were treated with percutaneous catheter closure. The whole procedure was guided andmonitored by TTE and fluoroscopy. The maximum diameter of the RRSVA was measured by TTE before and after thecatheter passed through the rupture site. A duct occluder 2 mm larger than the maximum diameter was chosen. Theclosure effects were evaluated with TTE and fluoroscopy immediately after the occluding device was deployed. Allpatients were followed up by TTE for 8 to 30 months.Results Before the catheter passed through the rupture site the maximum diameter of the RRSVA measured with TTEand aortography were (7.9 ± 2.1) mm and (7.8 ± 1.8) mm. After the catheter passed through the rupture site themaximum diameter measured with TTE was (11.2 ± 3.2) mm, which was significantly larger than before the procedure (P<0.05). The percutaneous catheter closure was successful in four cases and failed in one. Compared to the aortographythe TTE was better at distinguishing residual shunts from aortic valve regurgitation immediately after the occluding devicewas deployed. There were no complications during 8 to 30 months of follow-up.Conclusion Transthoracic echocardiography can play an important role during percutaneous catheter closure of RRSVA,especially for estimating the size of the RRSVA after the catheter passes through the rupture site, and differentiatingresidual shunt from aortic valve regurgitation immediately after the occluding device is deployed.