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Sinus of Valsalva Aneurysms

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Abstract

Sinus of Valsalva aneurysms are rare but important entities. They are predominantly congenital in origin resulting from incomplete fusion of the aortic media and the aortic valve annulus. Less frequently, they may be acquired, usually secondary to infective endocarditis. Unruptured aneurysms may be clinically silent and diagnosed incidentally, or produce symptoms secondary to mass effect on related structures. Rupture of the sinus, with a resultant large left-to-right shunt, and severe congestive heart failure can be a life-threatening situation. Early diagnosis is crucial and can usually be made reliably by transthoracic echocardiography. However, transesophageal echocardiography may sometimes be required for confirmation. Cardiovascular magnetic resonance imaging and multi-detector computed tomography are being increasingly utilized for evaluation of sinus of Valsalva and can offer valuable complimentary information. Surgical repair is the predominant mode of treatment for both ruptured and unruptured aneurysms and has low complication rates. In recent years transcatheter techniques have emerged as a nonsurgical option for repair. This chapter provides an overview of the pathological and clinical aspects of sinus of Valsalva aneurysms and focuses on the treatment modalities.

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References

  1. Charitos EI, Sievers HH. Anatomy of the aortic root: implications for valve-sparing surgery. Ann Cardiothorac Surg. 2013;2:53–6.

    PubMed  PubMed Central  Google Scholar 

  2. Leyh RG, Schmidtke C, Sievers HH, Yacoub MH. Opening and closing characteristics of the aortic valve after different types of valve-preserving surgery. Circulation. 1999;100:2153–60.

    Article  CAS  Google Scholar 

  3. Schmidtke C, Sievers HH, Frydrychowicz A, et al. First clinical results with the new sinus prosthesis used for valve-sparing aortic rootreplacement. Eur J Cardiothorac Surg. 2013;43:585–90.

    Article  Google Scholar 

  4. Edwards JE, Burchell HB. Specimen exhibiting the essential lesion in aneurysm of the aortic sinus. Proc Staff Meet Mayo Clin. 1956;31:407–12.

    CAS  PubMed  Google Scholar 

  5. Bricker AO, Avutu B, Mohammed TL, et al. Valsalva sinus aneurysms: findings at CT and MR imaging. Radiographics. 2010;30:99–110.

    Article  Google Scholar 

  6. Ott DA. Aneurysm of the sinus of Valsalva. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2006;2006:165–76.

    Article  Google Scholar 

  7. Moustafa S, Mookadam F, Cooper L, et al. Sinus of Valsalva aneurysms—47 years of a single center experience and systematic overview of published reports. Am J Cardiol. 2007;99:1159–64.

    Article  Google Scholar 

  8. Weinreich M, Yu PJ, Trost B. Sinus of Valsalva aneurysms: review of the literature and an update on management. Clin Cardiol. 2015;38:185–9.

    Article  Google Scholar 

  9. Mayer ED, Ruffmann K, Saggau W, et al. Ruptured aneurysms of the sinus of Valsalva. Ann Thorac Surg. 1986;42:81–5.

    Article  CAS  Google Scholar 

  10. Meier JH, Seward JB, Miller FA, et al. Aneurysms in the left ventricular outflow tract: clinical presentation, causes, and echocardiographic features. J Am Soc Echocardiogr. 1998;11:729–45.

    Article  CAS  Google Scholar 

  11. Nakamura Y, Aoki M, Hagino I, et al. Case of congenital aneurysm of sinus of Valsalva with common arterial trunk. Ann Thorac Surg. 2014;97:710–2.

    Article  Google Scholar 

  12. Prifti E, Ademaj F, Baboci A, Nuellari E, Demiraj A, Thereska D. Surgical treatment of a giant unruptured aneurysm of the noncoronary sinus of Valsalva: a case report. J Med Case Rep. 2016;10:252.

    Article  Google Scholar 

  13. Feldman DN, Roman MJ. Aneurysms of the sinuses of Valsalva. Cardiology. 2006;106:73–81.

    Article  Google Scholar 

  14. Wang KY, St John Sutton M, Ho HY, Ting CT. Congenital sinus of Valsalva aneurysm: a multiplane transesophageal echocardiographic experience. J Am Soc Echocardiogr. 1997;10:956–63.

    Article  CAS  Google Scholar 

  15. Blackshear JL, Safford RE, Lane GE, Freeman WK, Schaff HV. Unruptured noncoronary sinus of Valsalva aneurysm: preoperative characterization by transesophageal echocardiography. J Am Soc Echocardiogr. 1991;4:485–90.

    Article  CAS  Google Scholar 

  16. Dev V, Goswami KC, Shrivastava S, Bahl VK, Saxena A. Echocardiographic diagnosis of aneurysm of the sinus of Valsalva. Am Heart J. 1993;126:930–6.

    Article  CAS  Google Scholar 

  17. Thankavel PP, Lemler MS, Ramaciotti C. Unruptured sinus of Valsalva aneurysm in a neonate with hypoplastic left heart syndrome: echocardiographic diagnosis and features. Echocardiography. 2014;31:E85–7.

    Article  Google Scholar 

  18. Vatankulu MA, Tasal A, Erdogan E, Sonmez O, Goktekin O. The role of three-dimensional echocardiography in diagnosis and management of ruptured sinus of Valsalva aneurysm. Echocardiography. 2013;30:E260–2.

    Article  Google Scholar 

  19. Bricker AO, Avutu B, Mohammed TL, Williamson EE, Syed IS, Julsrud PR, Schoenhagen P, Kirsch J. Valsalva sinus aneurysms: findings at CT and MR imaging. Radiographics. 2010;30:99–110.

    Article  Google Scholar 

  20. Cullen S, Somerville J, Redington A. Transcatheter closure of a ruptured aneurysm of the sinus of Valsalva. Br Heart J. 1994;71:479–80.

    Article  CAS  Google Scholar 

  21. Rao PS, Bromberg BI, Jureidini SB, Fiore AC. Transcatheter occlusion of ruptured sinus of Valsalva aneurysm: innovative use of available technology. Catheter Cardiovasc Interv. 2003;58:130–4.

    Article  Google Scholar 

  22. Arora R, Trehan V, Rangasetty UM, Mukhopadhyay S, Thakur AK, Kalra GS. Transcatheter closure of ruptured sinus of Valsalva aneurysm. J Interv Cardiol. 2004;17:53–8.

    Article  Google Scholar 

  23. Abidin N, Clarke B, Khattar RS. Percutaenous closure of ruptured sinus of Valsalva aneurysm using an amplatzer occluder device. Heart. 2005;91:244.

    Article  CAS  Google Scholar 

  24. Chang CW, Chiu SN, Wu ET, Tsai SK, Wu MH, Wang JK. Transcatheter closure of a ruptured sinus of Valsalva aneurysm. Circ J. 2006;70:1043–7.

    Article  Google Scholar 

  25. Zhao SH, Yan CW, Zhu XY, et al. Transcatheter occlusion of the ruptured sinus of Valsalva aneurysm with an Amplatzer duct occluder. Int J Cardiol. 2008;129:81–5.

    Article  Google Scholar 

  26. Sen S, Chattopadhyay A, Ray M, Bandyopadhyay B. Transcatheter device closure of ruptured sinus of Valsalva: immediate results and short term follow up. Ann Pediatr Cardiol. 2009;2:79–82.

    Article  Google Scholar 

  27. Szkutnik M, Kusa J, Glowacki J, Fiszer R, Bialkowski J. Transcatheter closure of ruptured sinus of Valsalva aneurysms with an Amplatzer occluder. Rev Esp Cardiol. 2009;62:1317–21.

    Article  Google Scholar 

  28. Kerkar PG, Lanjewar CP, Mishra N, Nyayadhish P, Mammen I. Transcatheter closure of ruptured sinus of Valsalva aneurysm using the amplatzer duct occluder: immediate results and mid-term follow-up. Eur Heart J. 2010;31:2881–7.

    Article  Google Scholar 

  29. Guan L, Zhou D, Zhang F, et al. Percutaneous device closure of ruptured sinus of Valsalva aneurysm: a preliminary experience. J Invasive Cardiol. 2013;25:492–6.

    PubMed  Google Scholar 

  30. Neeraj RSA. Transcatheter device closure of ruptured sinus of Valsalva: not addressing the pathology, does it make a difference? TCT-680. J Am Coll Cardiol. 2013;20136218208:poster abstracts TCT-680 in TCT 2013.

    Google Scholar 

  31. Tong S, Zhong L, Liu J, et al. The immediate and follow-up results of transcatheter occlusion of the ruptured sinus of Valsalva aneurysm with duct occluder. J Invasive Cardiol. 2014;26:55–9.

    PubMed  Google Scholar 

  32. Rittger H, Gundlach U, Koch A. Transcatheter closure of ruptured sinus of Valsalva aneurysm into the right ventricle with an amplatzer vascular plug II. Catheter Cardiovasc Interv. 2015;85:166–9.

    Article  Google Scholar 

  33. Sinha SC, Sujatha V, Mahapatro AK. Percutaneous transcatheter closure of ruptured sinus of Valsalva aneurysm: immediate result and long-term follow-up. Int J Angiol. 2015;24:99–104.

    Article  Google Scholar 

  34. Hiratzka LF, Bakris GL, Beckman JA, et al.; 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; Society for Vascular Medicine. ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: executive summary. 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. Catheter Cardiovasc Interv. 2010;76:E43–86.

    Article  Google Scholar 

  35. Lillehei CW, Stanley P, Varco RL. Surgical treatment of ruptured aneurysms of the sinus of Valsalva. Ann Surg. 1957;146:459–72.

    Article  CAS  Google Scholar 

  36. Yan F, Huo Q, Qian J, et al. Surgery for sinus of Valsalva aneurysm: 27-year experience with 100 patients. Asian Cardiovasc Thorac Ann. 2008;16:361–5.

    Article  Google Scholar 

  37. Vural KM, Sener E, Tasdemir O, et al. Approach to sinus of Valsalva aneurysms: a review of 53 cases. Eur J Cardiothorac Surg. 2001;20:71–6.

    Article  CAS  Google Scholar 

  38. Sarikaya S, Adademir T, Elibol A, et al. Surgery for ruptured sinus of Valsalva aneurysm: 25 year experience with 55 patients. Eur J Cardiothorac Surg. 2013;43:591–6.

    Article  Google Scholar 

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Correspondence to Shahzad G. Raja .

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Soni, M.K., Raja, S.G. (2020). Sinus of Valsalva Aneurysms. In: Raja, S. (eds) Cardiac Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-24174-2_61

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  • DOI: https://doi.org/10.1007/978-3-030-24174-2_61

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