r-n-jРоссийский неврологический журналRussian neurological journal2658-79472686-7192МИА10.30629/2658-7947-2025-30-3-49-52r-n-j-712Research ArticleИССЛЕДОВАНИЯ И КЛИНИЧЕСКИЕ НАБЛЮДЕНИЯCLINICAL RESEARCHES AND CASE REPORTSИшемический инсульт на фоне тромбоза аневризмы синуса ВальсальвыIschemic stroke on the background of thrombosis of sinus of Valsalva aneurysmhttps://orcid.org/0000-0001-5679-4100МехряковС. А.MekhryakovS. A.

 Пермь

 Perm

heartolog@gmail.comhttps://orcid.org/0000-0001-6061-8118КулешА. А.KuleshA. A.

 Пермь

 Perm

aleksey.kulesh@gmail.comhttps://orcid.org/0000-0002-8305-1115СыромятниковаЛ. И.SyromyatnikovaL. I.

 Пермь

 Perm

ilarievna@gmail.comhttps://orcid.org/0009-0000-8975-7365КрапивинС.KrapivinS.

Пермь

 Perm 

sergejs.krap0001@gmail.comПермский государственный медицинский университет имени академика Е.А. ВагнераРоссияPerm State Medical University named after Academician E.A. WagnerRussian Federation2025080920253034952Copyright © Мехряков С.А., Кулеш А.А., Сыромятникова Л.И., Крапивин С., 20252025Мехряков С.А., Кулеш А.А., Сыромятникова Л.И., Крапивин С.Mekhryakov S.A., Kulesh A.A., Syromyatnikova L.I., Krapivin S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.r-n-j.com/jour/article/view/712Введение

Введение. Распространенность аневризмы синуса Вальсальвы (АСВ) в общей популяции составляет до 0,09%, а среди всех врожденных дефектов сердца от 0,1 до 3,5%. Одним из осложнений данной патологии является развитие церебральной эмболии.

 Материал и методы

 Материал и методы. Представлено описание клинического случая развития ишемического инсульта вследствие церебральной эмболии из тромбированной АСВ. Проведен обзор опубликованных случаев на тему клинической значимости тромбоза АСВ в развитии инсульта, проанализирована база данных медицинских и биологических публикаций PubMed.

 Результаты

 Результаты. Пациент 19 лет без хронических заболеваний и вредных привычек госпитализирован в сосудистый центр для проведения тромбоэкстракции из правой средней мозговой артерии. После успешного проведения реперфузионной терапии инициирован диагностический поиск. Трансторакальная эхокардиография выявила тромбированную АСВ. После проведения антикоагулятной терапии контрольная чреспищеводная эхокардиография продемонстировала лизис тромба. Пациенту в отсроченном порядке выполнена резекция АСВ.

 Заключение

 Заключение. Изученность проблемы эмболических осложнений на фоне АСВ низкая в силу крайне редкой распространенности данной аномалии. Эхокардиография является ключевым методом первичной визуализации АСВ и ее динамического наблюдения. Регламентированной тактики ведения пациентов с тромбозом АСВ не существует.

Introduction

Introduction. The prevalence of sinus of Valsalva aneurysm (SOVA) in the general population is up to 0.09%, and among all congenital heart defects from 0.1 to 3.5%. One of the complications of this pathology is the development of cerebral embolism.

 Aim

 Aim. To present a clinical case of ischemic stroke in a young patient with a rare cardiac pathology.

 Material and methods

 Material and methods. The article presents a description of a clinical case of the development of ischemic stroke due to cerebral embolism from a thrombosed SOVA. A review of all published cases on the clinical significance of SOVA thrombosis in the development of stroke was conducted, and the PubMed database of medical and biological publications was analyzed.

Results

Results. A 19-years old patient without chronic diseases or bad habits was hospitalized at the vascular center for thrombectomy from the right middle cerebral artery. After successful reperfusion therapy, a diagnostic search was initiated. Transthoracic echocardiography revealed thrombosis of SOVA. During anticoagulant therapy, control transesophageal echocardiography demonstrated thrombus lysis. The patient underwent delayed resection of the SOVA.

Conclusion

Conclusion. The study of the problem of embolic complications against the background of SOVA is low due to the extremely rare prevalence of this anomaly. Echocardiography is a key method for primary visualization of SOVA and its dynamic monitoring. There are no regulated tactics for managing patients with SOVA thrombosis.

ишемический инсультинсульт в молодом возрастеэмболияэхокардиографияаневризма синуса Вальсальвыischemic strokestroke in young adultsembolismechocardiographysinus of Valsalva aneurysmReferencesVerhemel S, Nuis RJ, van den Dorpel M, Adrichem R, de Sá Marchi MF, Hirsch A, Daemen J, Budde RPJ, Van Mieghem NM. Computed tomography to predict pacemaker need after trans-catheter aortic valve replacement. Journal of cardiovascular computed tomography. 2024 Nov-Dec;18(6):597–608. https://doi.org/10.1016/j.jcct.2024.08.009Verhemel S, Nuis RJ, van den Dorpel M, Adrichem R, de Sá Marchi MF, Hirsch A, Daemen J, Budde RPJ, Van Mieghem NM. Computed tomography to predict pacemaker need after trans-catheter aortic valve replacement. Journal of cardiovascular computed tomography. 2024 Nov-Dec;18(6):597–608. https://doi.org/10.1016/j.jcct.2024.08.009Xu B, Kocyigit D, Betancor J, Tan C, Rodriguez ER, Schoenhagen P, Flamm SD, Rodriguez LL, Svensson LG, Griffi n BP. Sinus of Valsalva Aneurysms: A State-of-the-Art Imaging Review. Journal of the American Society of Echocardiography. 2020 Mar;33(3):295–312. https://doi.org/10.1016/j.echo.2019.11.008Xu B, Kocyigit D, Betancor J, Tan C, Rodriguez ER, Schoenhagen P, Flamm SD, Rodriguez LL, Svensson LG, Griffi n BP. Sinus of Valsalva Aneurysms: A State-of-the-Art Imaging Review. Journal of the American Society of Echocardiography. 2020 Mar;33(3):295–312. https://doi.org/10.1016/j.echo.2019.11.008Weinreich M, Yu PJ, Trost B. Sinus of valsalva aneurysms: review of the literature and an update on management. Clinical Cardiol. 2015 Mar;38(3):185–9. https://doi.org/10.1002/clc.22359Weinreich M, Yu PJ, Trost B. Sinus of valsalva aneurysms: review of the literature and an update on management. Clinical Cardiol. 2015 Mar;38(3):185–9. https://doi.org/10.1002/clc.22359Thomas VV, Thomas JM, Iyadurai R. Cardioembolic Stroke in Sinus of Valsalva Aneurysm, A Case Report. Neurology India. 2023 Sep-Oct;71(5):998–1001. https://doi.org/10.4103/0028-3886.388106Thomas VV, Thomas JM, Iyadurai R. Cardioembolic Stroke in Sinus of Valsalva Aneurysm, A Case Report. Neurology India. 2023 Sep-Oct;71(5):998–1001. https://doi.org/10.4103/0028-3886.388106Ruzieh M, Shafi q Q, Murphy L. Bonnell M, Khouri S. Embolic Stroke Due to Sinus of Valsalva Aneurysm Thrombus. The American journal of the medical sciences. 2016 Sep;352(3):333-4. https://doi.org/10.1016/j.amjms.2016.05.033Ruzieh M, Shafi q Q, Murphy L. Bonnell M, Khouri S. Embolic Stroke Due to Sinus of Valsalva Aneurysm Thrombus. The American journal of the medical sciences. 2016 Sep;352(3):333-4. https://doi.org/10.1016/j.amjms.2016.05.033Stöllberger C, Seitelberger R, Fenninger C. Prainer C, Slany J. Aneurysm of the left sinus of Valsalva. An unusual source of cerebral embolism. Stroke. 1996 Aug;27(8):1424–6. https://doi.org/10.1161/01.str.27.8.1424Stöllberger C, Seitelberger R, Fenninger C. Prainer C, Slany J. Aneurysm of the left sinus of Valsalva. An unusual source of cerebral embolism. Stroke. 1996 Aug;27(8):1424–6. https://doi.org/10.1161/01.str.27.8.1424Shahrabani RM, Jairaj PS. Unruptured aneurysm of the sinus of Valsalva: a potential source of cerebrovascular embolism. British Heart Journal. 1993 Mar;69(3):266–7. https://doi.org/10.1136/hrt.69.3.266Shahrabani RM, Jairaj PS. Unruptured aneurysm of the sinus of Valsalva: a potential source of cerebrovascular embolism. British Heart Journal. 1993 Mar;69(3):266–7. https://doi.org/10.1136/hrt.69.3.266Isselbacher EM, Preventza O, Hamilton Black J 3rd, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A Jr, Fanola CL, Girardi LN, Hicks CW, Hui DS, Schuyler Jones W, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Gyang Ross E, Schermerhorn ML, Singleton Times S, Tseng EE, Wang GJ, Woo YJ. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2022 Dec 13;146(24):e334-e482. https://doi.org/10.1161/cir.0000000000001106Isselbacher EM, Preventza O, Hamilton Black J 3rd, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A Jr, Fanola CL, Girardi LN, Hicks CW, Hui DS, Schuyler Jones W, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Gyang Ross E, Schermerhorn ML, Singleton Times S, Tseng EE, Wang GJ, Woo YJ. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2022 Dec 13;146(24):e334-e482. https://doi.org/10.1161/cir.0000000000001106Mazzolai L, Teixido-Tura G, Lanzi S, Boc V, Bossone E, Brodmann M, Bura-Rivière A, De Backer J, Deglise S, Della Corte A, Heiss C, Kałużna-Oleksy M, Kurpas D, McEniery CM, Mirault T, Pasquet AA, Pitcher A, Schaubroeck HAI, Schlager O, Sirnes PA, Sprynger MG, Stabile E, Steinbach F, Thielmann M, van Kimmenade RRJ, Venermo M, Rodriguez-Palomares JF; ESC Scientifi c Document Group. 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases. European Heart Journal, Volume 45, Issue 36, 21 September 2024, Pages 3538–3700. https://doi.org/10.1093/eurheartj/ehae179Mazzolai L, Teixido-Tura G, Lanzi S, Boc V, Bossone E, Brodmann M, Bura-Rivière A, De Backer J, Deglise S, Della Corte A, Heiss C, Kałużna-Oleksy M, Kurpas D, McEniery CM, Mirault T, Pasquet AA, Pitcher A, Schaubroeck HAI, Schlager O, Sirnes PA, Sprynger MG, Stabile E, Steinbach F, Thielmann M, van Kimmenade RRJ, Venermo M, Rodriguez-Palomares JF; ESC Scientifi c Document Group. 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases. European Heart Journal, Volume 45, Issue 36, 21 September 2024, Pages 3538–3700. https://doi.org/10.1093/eurheartj/ehae179

The authors declare that there are no conflicts of interest present.