Severe hypotension and overflowing of venous reservoir at the initiation of cardiopulmonary bypass in a patient undergoing repair of ruptured sinus of Valsalva aneurysm: management issues

Aneurysm of sinus of Valsalva is a rare cardiac lesion that may be acquired or congenital. The presentations of RSOV range from incidental detection to frank heart failure. Right sinus of Valsalva aneurysm usually ruptures into the right ventricle. If non-coronary sinus is involved, most aneurysms erode into the right atrium. The problems described with surgical repair of RSOV include--distension of the communicating chamber at initiation of cardiopulmonary bypass (CPB), limited ability to achieve cardiac arrest if RSOV is misdiagnosed as ventricular septal defect, and air entrainment in venous drainage line on opening of the aorta, if tricuspid valve is regurgitant and total CPB is not established. We report severe hypotension and overflowing of the venous reservoir at initiation of CPB in a patient having RSOV with significant tricuspid regurgitation and discuss its optimal management.