Sinus of Valsalva Aneurysm Clinical Presentation

  • Author: Anuradha Tunuguntla, MD, FACC; Chief Editor: Park W Willis IV, MD  more...
Updated: Jul 15, 2014


Approximately 25% of reported cases of sinus of Valsalva aneurysm (SVA) are clinically asymptomatic, unruptured SVA detected by routine 2-dimensional echocardiography. Rupture of the aneurysmal sac may occur spontaneously, precipitated by exertion, trauma, or cardiac catheterization.

A ruptured SVA progresses in 3 stages as described by Blackshear and colleagues, as follows:[8]

  • Acute chest or right upper quadrant pain
  • Subacute dyspnea on exertion or at rest (heart failure syndrome) with progressive or acute onset
  • Progressive cough, dyspnea, edema, and oliguria

Atypically, SVA presents with infective endocarditis, which may originate at the edges of the aneurysm.

Palpitations or syncope may present secondary to obstruction of the left or right ventricular outflow tract.

Dyspnea is by far the most common presenting symptom.



Unruptured SVA is often asymptomatic and has almost no physical signs. When SVA ruptures, few specific signs of left-to-right shunting may become apparent, and these are often indistinguishable from coronary arteriovenous fistula. Clinical suspicion followed by prompt echocardiographic confirmation is key to diagnosis.

Signs include the following:

  • A loud, superficial, "machine-type" continuous murmur is accentuated in diastole in as many as 40% of patients.
  • A palpable thrill along the right or left lower parasternal border is occasionally noticeable.
  • Bounding pulses are occasionally present.
  • In one series, approximately 44% of the patients had associated aortic regurgitation.[7]


Primary causes are congenital.

Secondary causes include the following:

  • Atherosclerosis
  • Syphilis
  • Cystic medial necrosis or Marfan syndrome
  • Blunt or penetrating chest injury
  • Infective endocarditis

Associated congenital defects include the following:

  • Ventricular septal defect
  • Aortic insufficiency
  • Coarctation
Contributor Information and Disclosures

Anuradha Tunuguntla, MD, FACC Interventional Cardiologist, Director of Cardiac Catheterization Lab, Veterans Affairs Medical Center of Wilkes Barre, PA

Anuradha Tunuguntla, MD, FACC is a member of the following medical societies: American College of Cardiology, Society for Cardiovascular Angiography and Interventions

Disclosure: Nothing to disclose.


Elyse Foster, MD Director of Non-Invasive Cardiology, Department of Medicine, Division of Cardiology, Professor of Medicine, University of California, San Francisco, School of Medicine

Elyse Foster, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Heart Association, American Society of Echocardiography

Disclosure: Received grant/research funds from Abbott Vascular Structural Heart for research.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Steven J Compton, MD, FACC, FACP, FHRS Director of Cardiac Electrophysiology, Alaska Heart Institute, Providence and Alaska Regional Hospitals

Steven J Compton, MD, FACC, FACP, FHRS is a member of the following medical societies: American College of Physicians, American Heart Association, American Medical Association, Heart Rhythm Society, Alaska State Medical Association, American College of Cardiology

Disclosure: Nothing to disclose.

Chief Editor

Park W Willis IV, MD Sarah Graham Distinguished Professor of Medicine and Pediatrics, University of North Carolina at Chapel Hill School of Medicine

Park W Willis IV, MD is a member of the following medical societies: American Society of Echocardiography

Disclosure: Nothing to disclose.


William J Stewart, MD Professor, Department of Cardiovascular Disease, The Cleveland Clinic Lerner College of Medicine

William J Stewart, MD, is a member of the following medical societies: American College of Cardiology and American Society of Echocardiography

Disclosure: Nothing to disclose.

Wai Hong Wilson Tang, MD Associate Professor of Medicine, Section of Heart Failure and Cardiac Transplantation Medicine, Cleveland Clinic Foundation

Wai Hong Wilson Tang, MD is a member of the following medical societies: American College of Cardiology, American Heart Association, American Society for Clinical Investigation, Heart Failure Society of America, and International Society for Heart and Lung Transplantation

Disclosure: Nothing to disclose.

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