Presentation
Degenerative dilatation of the SOV affects all three SOVs to a similar degree, whereas in the presented case the aneurysm was confined to the left SOV. [ahajournals.org]
Medical management involves treating arrhythmias as needed, treating endocarditis if present, and treating heart failure if present. [ncbi.nlm.nih.gov]
Tuesday, July 28, 2015 By Purpose This is the case of a 64-year-old male who presented with right-sided heart failure symptoms. [ctsnet.org]
Case presentation A 23-year-old female Chinese university student presented to the emergency department with acute onset dyspnoea, chest pain, palpitations and dizziness for 2 days. [bmccardiovascdisord.biomedcentral.com]
Workup
Sections Sinus of Valsalva Aneurysm Overview Background Pathophysiology Etiology Epidemiology Prognosis Show All Presentation History Physical Examination Show All DDx Workup Imaging Studies Procedures Show All Treatment Approach Considerations Medical [emedicine.medscape.com]
Unruptured SOV aneurysms Overall, unruptured aneurysms are asymptomatic and are incidentally detected during imaging workup of heart murmurs or abnormal cardiomediastinal silhouette on radiograph ( 16 ). [ncbi.nlm.nih.gov]
Each group is given a score of 1 if a feature is present, and the total score helps pave the next steps of workup—a score of 0 can be followed by diagnostic workup of other pathologies, while scores of 2–3 should be followed by expedited workup and immediate [intechopen.com]
Other ECG Findings
- Ischemic Changes
The ECG did not show any ischemic changes apart from poor anterior R-wave progression. A chest radiograph showed mild cardiomegaly. An echocardiogram was performed that showed two large sinus of Valsalva aneurysms (Figure 1 and Movie I). [ahajournals.org]
Treatment
Treatment includes blood pressure control but surgical repair may be needed, especially if the aneurysm ruptures. [en.wikipedia.org]
Surgical repair remains the preferred method of treatment, although transcatheter closure devices are an acceptable treatment for patients with suitable anatomy and high risk for cardiac surgery. [ncbi.nlm.nih.gov]
Prognosis
The prognosis seems to improve if aortic valve replacement and aortocoronary bypass can be avoided.10 After surgical repair, the prognosis is usually good and the risk of recurrence is rare. Correspondencia: Dra. M. Regueiro Abel. [revespcardiol.org]
Prognosis in patients with a ruptured aneurysm who have not undergone surgical repair may be poor, with survival beyond 1 year uncommon. [chdbabies.com]
Specialty Cardiology Complications Rupture, heart failure, stroke Diagnostic method Echocardiogram, cardiac CT scan, cardiac MRI scan Treatment Blood pressure control, surgery Medication Beta-adrenoceptor antagonists Prognosis Median survival after rupture [en.wikipedia.org]
Etiology
Left to right shunting is the usual underlying etiology of decompensation. [ncbi.nlm.nih.gov]
An anatomic etiology of symptoms may be suspected with heart auscultation (murmur), and diagnosis is made by a routine echocardiogram or, if the patient is suspected of having coronary disease as the etiology of symptoms, an angiogram. [hqmeded-ecg.blogspot.com]
Etiology Sinus of Valsalva aneurysm may be either congenital or acquired. [radiopaedia.org]
Root replacement or Ross procedure maybe used if severe local septic etiology. Complications Rupture into RV > RA > LV > IVS/PA leads to formation intracardiac fistulae or tamponade. [pie.med.utoronto.ca]
[…] and acquired lesion by Jones and Langley in 1949 • 1st diagnosis of rupture during life by Venning in 1951 • 1st. successful repair with CPB in 1956 at Mayo Clinic & University of Minnesota using CPB Aneurysm of Sinus Valsalva • Clinical features • Etiology [slideserve.com]
Epidemiology
the life expectancy without treatment is approximately four years.[8] Surgery carries a 1% risk of intra-operative death with higher risks associated with infected aneurysms, and 5- to 10-year survival rates following surgery range from 82-97%.[8] Epidemiology [en.wikipedia.org]
Sections Sinus of Valsalva Aneurysm Overview Background Pathophysiology Etiology Epidemiology Prognosis Show All Presentation History Physical Examination Show All DDx Workup Imaging Studies Procedures Show All Treatment Approach Considerations Medical [emedicine.medscape.com]
Pathophysiology
[…] of SVAs originate from the right sinus of Valsalva, whereas SVAs originating from noncoronary (10-30%) and left sinuses (< 5%) are exceedingly rare. [1] SVA is commonly associated with aortic valve regurgitation and/or ventricular septal defect. [2] Pathophysiology [emedicine.medscape.com]
Associated conditions include: Syphilis Trauma Endocarditis Atherosclerosis Marfans (diffuse dilatation) Uncommon – Ehlers Danlos (other connective tissue disorders), Takayasu arteritis (other vasculitides), post AV replacement Pathophysiology Congenital [pie.med.utoronto.ca]
Sinus Valsalva Aneurysm • Pathophysiology • Thinning of the aorta medial layer in the wall of a sinus of Valsalva results in an aneurysmal dilation, which may extend and rupture into a corresponding cardiac chamber, forming an aortocardiac fistula. • [slideserve.com]
[…] intracardiac shunting caused by rupture of the SVA into the right side of the heart. [1] Approximately 65-85% of SVAs originate from the right sinus of Valsalva, while SVAs originating from noncoronary (10-30%) and left sinuses (< 5%) are exceedingly rare. [2] Pathophysiology [emedicine.com]
Prevention
The function of the normal sinuses is to prevent occlusion of the coronary artery ostia during systole when the aortic valve opens. The normal sinus diameter is less than 4.0 cm for men and 3.6 cm for women. [perfusfind.com]
Deterrence/Prevention Because the genetic mutation that causes the sinus of Valsalva aneurysm is presumed to be spontaneous, no preventive measures are available. [chdbabies.com]
Children’s heart conditions can’t be prevented, but a lot can be done to improve and often completely repair their hearts at any age. [nemours.org]
This improvement was the result of the prevention (control of hypertension, excluding strenuous physical activity), the earlier diagnosis, and the elective early surgery. [vascular-endovascular-therapy.imedpub.com]