head JofIMAB
Journal of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski Publishing Ltd.
ISSN: 1312-773X (Online)
Issue: 2024, vol. 30, issue1
Subject Area: Medicine
DOI: 10.5272/jimab.2024301.5308
Published online: 18 January 2024

Original article
J of IMAB. 2024 Jan-Mar;30(1):5308-5313
Blagovest Stoimenov1ORCID logoCorresponding Autoremail, Lyubomir Gaydarski2ORCID logo, Svetla Dineva3ORCID logo, Ralitsa Pancheva1ORCID logo,
1) Department of Propaedeutics of Internal Diseases, UMHAT "Alexandrovska", Medical Faculty, Medical University - Sofia, Bulgaria.
2) Department of Anatomy, Histology and Embryology, Medical University - Sofia, Bulgaria.
3) Department of Imaging UMHAT "Alexandrovska, Medical University - Sofia, Bulgaria.

Aneurysms of the Valsalva sinuses are rare among cardiovascular disorders, with an incidence rate of 0.15%. Most cases are accidentally diagnosed or constated postmortem. Usually, this type of pathology is asymptomatic and might go undetected for a long time before the aneurism erupts. Patients with larger coronary aneurysms often complain of from chest pain, shortness of breath, and arrhythmia. Another extremely rare cardiovascular pathology is the aneurysm of the subclavian artery, which has a reported rate of 0.13%. Smaller subclavian aneurysms have no clinical manifestation, whereas larger ones cause murmur, pulsation phenomenons, neuropathic pain and ischemia of the upper limb due to compression of the brachial plexus and major vessels.
Herein, we report a rare case of a very large aneurisms involving all three coronary sinuses and the whole aortic root in combination with a bilateral giant subclavian aneurism. These findings were made during a routine cardiological examination and further hospitalizations of a 54-year-old woman with chest pain and high blood pressure complaints with known ankylosing spondylitis. Despite their rarity, aneurysms of the sinuses of Valsalva and subclavian arteries are of utmost clinical significance due to the life-threatening complications which might arise from their rupture. Furthermore, such aneurysms pose significant technical difficulties during angiographic procedures. Therefore, detailed knowledge of such pathologies is essential for correctly diagnosing and treating such patients.

Keywords: Aneurysm, Aortic, Coronary, Ankylosing spondylitis, Cardiovascular,

pdf - Download FULL TEXT /PDF 1152 KB/
Please cite this article as: Stoimenov B, Gaydarski L, Dineva S, Pancheva R. Case of a female patient with ankylosing spondylitis and multiple aneurysms. J of IMAB. 2024 Jan-Mar;30(1):5308-5313. [Crossref - 10.5272/jimab.2024301.5308]

Corresponding AutorCorrespondence to: Blagovest Stoimenov, Department of Propaedeutics of Internal Diseases, UMHAT "Alexandrovska"; Medical Faculty, Medical University – Sofia; 1, St Georgi Sofiiski Str., Sofia, Bulgaria; E-mail: stoimenov90@gmail.com

1. Takach TJ, Reul GJ, Duncan JM, Cooley DA, Livesay JJ, Ott DA, et al. Sinus of Valsalva aneurysm or fistula: management and outcome. Ann Thorac Surg. 1999 Nov;68(5):1573-7 [PubMed]
2. Moustafa S, Mookadam F, Cooper L, Adam G, Zehr K, Stulak J, et al. Sinus of Valsalva Aneurysms-47 Years of a Single Center Experience and Systematic Overview of Published Reports. Am J Cardiol. 2007 Apr 15;99(8):1159-1164. [Crossref]
3. Feldman DN, Roman MJ. Aneurysms of the sinus of Valsalva. Cardiology. 2006;106(2):73-81. [PubMed]
4. Gelfand EV, Bzymek D, Johnstone MT. Images in cardiovascular medicine: sinus of Valsalva aneurysm with right ventricular outflow tract obstruction—evaluation with Doppler, real-time 3-dimensional and contrast echocardiography. Circulation. 2007 Jan 16;115(2):e16–e17. [PubMed]
5. Dent TL, Lindenauer SM, Ernest CB, Fry WJ. Multiple atherosclerotic arterial aneurysms. Arch Surg. 1972 Aug;105(2):338-44. [PubMed]
6.  Davidović LB, Marković DM, Pejkić SD, Kovacević NS, Colić MM, Dorić PM.Davidovic L, Markovic D, Pejkic S, Kovacevic N, Colic M, Doric P. Subclavian artery aneurysms. Asian J Surg. 2003 Jan;26(1):7-11. [PubMed]
7. Pairolero PC, Walls JT, Payne WS, Hollier LH, Fairbairn JF 2nd. Subclavian-axillary artery aneurysms. Surgery. 1981 Oct;90(4):757-63. [PubMed]
8. Hope J. (ed.). A treatise on the disease of the heart and great vessels. 3rd ed. Philadelphia, PA: Lea and Blanchard, 1839, pp. 466–471.
9. Thurnam J. On aneurisms, and especially spontaneous varicose aneurisms of the ascending aorta, and sinuses of Valsalva: with cases. Med Chir Tr. 1840;23:323-84. [PubMed]
10. Smith WA. Aneurysm of the sinus of Valsalva with report of two cases. JAMA. 1914 Jun 13;62(24):1878-1880. [Crossref]
11. Ott DA. Aneurysm of the sinus of valsalva. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2006:165-76. [PubMed]
12. Bricker AO, Avutu B, Mohammed TL, Williamson EE, Syed IS, Julsrud PR, et al. Valsalva sinus aneurysms: findings at CT and MR imaging. Radiographics. 2010 Jan;30(1):99-110. [PubMed]
13. Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE. Jr, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/ STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation. 2010 Apr 6;121(13):266-e369. [Crossref]
14. Zhan B, Zhang S, Shao Y. Operation for huge subclavian artery aneurysm: a case report. J Thorac Dis. 2010 Jun;2(2):117-20. [PubMed]
15. McCollum CH, Da Gama AD, Noon GP, DeBakey ME. Aneurysm of the subclavian artery. J Cardiovasc Surg (Torino). 1979 Mar-Apr;20(2):159-64. [PubMed]
16. Coselli JS, Crawford ES. Surgical treatment of aneurysms of the intrathoracic segment of the subclavian artery. Chest. 1987 May;91(5):704-8. [PubMed]
17. Bin HG, Kim MS, Kim SC, Keun JB, Lee JH, Kim SS. Intrathoracic aneurysm of the right subclavian artery presenting with hoarseness: a case report. J Korean Med Sci. 2005 Aug;20(4):674-6. [PubMed]
18. Vierhout BP, Zeebregts CJ, van den Dungen JJAM, Reijnen MMPJ. Changing profiles of diagnostic and treatment options in subclavian artery aneurysms. Eur J Vasc Endovasc Surg. 2010 Jul;40(1):27-34. [PubMed]
19. Malekpour F, Hebeler K, Kirkwood ML. Open surgical approach for type II endoleak in subclavian artery pseudoaneurysm presented with neurological symptoms after endovascular repair. Vasc Endovascular Surg. 2020 Jul;54(5):467-70. [PubMed]
20. Maskanakis A, Patelis N, Moris D, Tsilimigras DI, Schizas D, Diakomi M, et al. Stenting of subclavian artery true and false aneurysms: a systematic review. Ann Vasc Surg. 2018 Feb;47:291-304. [PubMed]
21. Lee KS, Jung Y, Jeong IS, Song SY, Na KJ, Oh SG. Open surgical treatment of subclavian artery pseudoaneurysm after endovascular repair: a case report. J Cardiothorac Surg. 2022 Feb 26;17(1):25. [PubMed]
22. Miller RJH, Moore R, Kim B, Mosher D, Alvarez N. Inflammatory aortic aneurysm in a young patient with ankylosing spondylitis. J Vasc Surg. 2017 Aug;66(2):600-604. [PubMed]

Received: 11 September 2023
Published online: 18 January 2024

back to Online Journal