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Aneurysm of Sinus of Valsalva

Aneurysm of Ascending Aorta


Presentation

  • Rupture of aneurysm of sinus of Valsalva into the right atrium mimicking tricuspid valve endocarditis is a rare presentation. We review a case of spontaneous rupture of aneurysm of sinus of Valsalva into the right atrium presenting as a murmur.[ncbi.nlm.nih.gov]
  • Sinus of Valsalva aneurysm (SOVA), a congenital or acquired cardiac defect that is present in roughly 0.09% of the general population, often presents as an incidental finding during cardiac imaging.[ncbi.nlm.nih.gov]
  • Our approach to this subset of patients and an algorithm-dependent classification are presented. Between 1985 and 2000, 53 patients (mean age: 24 /-12; range 4--60) underwent repair for ruptured (64%) or non-ruptured (36%) SVA.[ncbi.nlm.nih.gov]
  • When present, it is usually in either the right (65–85%) or in the noncoronary (10–30%) sinus, rarely in the left ( 5%) sinus.[en.wikipedia.org]
  • A 26-year-old male with fungal aortic endocarditis is presented in whom unique M-mode and two-dimensional echocardiographic findings permitted a diagnosis of mycotic aneurysm of right sinus of Valsalva and ventricular septal abscess preoperatively.[ncbi.nlm.nih.gov]
Developmental Delay
Pleural Effusion
  • Note is made about bilateral small pleural effusion and descending thoracic aortic graft for aneurysm repair.[ncbi.nlm.nih.gov]
  • There were signs of biventricular heart failure, right-sided pleural effusion, mitral and aortic regurgitation.[omicsonline.org]

Workup

  • 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]
Pleural Effusion
  • Note is made about bilateral small pleural effusion and descending thoracic aortic graft for aneurysm repair.[ncbi.nlm.nih.gov]
  • There were signs of biventricular heart failure, right-sided pleural effusion, mitral and aortic regurgitation.[omicsonline.org]

Treatment

  • The patient had a successful postsurgical recovery and was discharged home with anticoagulation treatment.[ncbi.nlm.nih.gov]
  • Early diagnosis and immediate surgical treatment can save the patient's life in most cases. All the 3 cases reported in this series had aneurysm of right sinus of Valsalva with associated VSD and mild degree of aortic regurgitation (AR).[ncbi.nlm.nih.gov]
  • Although surgery has previously been the treatment of choice, transcatheter techniques have added to the spectrum of nonsurgical alternatives for repair. We report here 4 incidental SOVA cases and review the current literature.[ncbi.nlm.nih.gov]
  • Treatment Therapy for Aneurysm of sinus Valsalva includes controlling blood pressure by use of medicines, such as beta-blockers. However, the long-term treatment is surgical repair.[medigest.uk]
  • Please consult your own licensed physician regarding diagnosis and treatment of any medical condition! Please see also our disclaimer . This site complies with the HONcode standard for health information: verify here . Database updated 2019-02-19.[diseasesdatabase.com]

Prognosis

  • Prognosis in patients with a ruptured aneurysm who have not undergone surgical repair may be poor, with survival beyond 1 year uncommon.[chdbabies.com]
  • Treatment and prognosis Surgical repair with a Bentall procedure could be performed.[radiopaedia.org]
  • Urgent surgical repair for ruptures aneurysms Many recommend surgical repair of non-ruptures aneurysms as well Complications Rupture (see above) Myocardial infarction Heart block Right ventricular outflow tract obstruction Cardiac tamponade Sudden death Prognosis[learningradiology.com]
  • Recently, the prognosis after surgical repair has been reported to be excellent, with a 10-year survival rate of 90% ( 8 ).[jtd.amegroups.com]
  • Following successful surgical repair of a ruptured aneurysm, the prognosis is excellent with 10-year survival rates of 90%–95% ( 45 , 46 ).[ncbi.nlm.nih.gov]

Etiology

  • 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]
  • 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]
  • For etiology, SOV aneurysms are commonly congenital and represent 0.1% to 3.5% of congenital heart defects ( 6 , 7 ).[ncbi.nlm.nih.gov]
  • 12 left ventricle, 4 left atrium, 4 or pericardial space. 4, 13 Also rarely, a sinus aneurysm dissects into the interventricular septum, where it remains unruptured or perforates and ruptures into the left or right ventricle. 5, 14 – 16 A congenital etiology[clinicalgate.com]

Epidemiology

  • Cardiac tamponade may occur if the rupture involves the pericardial space. [1] Epidemiology Frequency United States SVA was present in 0.09% of cadavers in a large autopsy series and ranged to 0.14-0.23% in a Western surgical series. [4] Two-dimensional[emedicine.com]
  • Epidemiology Frequency United States Sinus of Valsalva aneurysm comprises approximately 0.1-3.5% of all congenital cardiac anomalies. Discovery in the pediatric age group is unusual.[emedicine.com]
  • Chest trauma, vasculitic diseases, and iatrogenic injury during aortic valve replacement have all been reported as causes of acquired SOVA.[ 1, 6-8 ] Epidemiology Although the true prevalence of SOVAs is unknown, the estimated rate is approximately 0.09%[onlinelibrary.wiley.com]
Sex distribution
Age distribution

Pathophysiology

  • 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]
  • […] 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]
  • Pathophysiology Aneurysmal dilatation of the sinuses of Valsalva occurs when the aortic media is defective, allowing separation of the media from the aortic annulus fibrosus.[chdbabies.com]
  • Pathophysiology Aneurysmal dilatation of the sinuses of Valsalva occurs when the aortic media is defective, allowing separation of the media from the aortic annulus fibrosus. [3] The defect is inherited, but frank aneurysmal dilatation is rarely seen[emedicine.com]

Prevention

  • 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]
  • Such a consideration may prevent some instances of congenital aneurysms from being missed simply because they have not been reported.[pediatrics.aappublications.org]
  • This encourages early surgical intervention, which helps prevent the development of worse symptoms and more extensive disease leading to more complicated and less satisfying repairs.[doi.org]
  • They provide a space to prevent blocking of the coronary artery orifices from the open aortic leaflets.[ncbi.nlm.nih.gov]
  • Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the[emedicine.com]

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