eMedicine Specialties > Cardiology > Congenital Heart Disease in the Adult

Sinus of Valsalva Aneurysm: Differential Diagnoses & Workup

Author: Wai Hong Wilson Tang, MD, Assistant Professor of Medicine, Section of Heart Failure and Cardiac Transplantation Medicine, Cleveland Clinic Foundation
Coauthor(s): William J Stewart, MD, Associate Professor, Department of Cardiology, The Cleveland Clinic Foundation and Ohio State University
Contributor Information and Disclosures

Updated: Jan 28, 2009

Differential Diagnoses

Aortic Stenosis
Isolated Coronary Artery Anomalies
Atrial Septal Defect
Ventricular Septal Defect
Atrioventricular Block
Cardiomyopathy, Dilated
Cardiomyopathy, Hypertrophic

Other Problems to Be Considered

Chest pain
Arrhythmia/syncope
May mimic myocardial infarction or presents with cerebrovascular embolism7,8

Workup

Imaging Studies

  • Cine magnetic resonance imaging (MRI) is the criterion standard.
  • Multiplane transesophageal echocardiography (TEE) provides conclusive information regarding SVA and allows precise identification of structural anomalies and shunt locations for perioperative assessment.9,3
  • Two-dimensional transthoracic echocardiography (TTE) may detect as many as 75% of all patients with SVA.10 Usually TEE or MRI is needed to confirm the diagnosis and for perioperative assessment. Features of TTE include the following:
    • Generalized single sinus enlargement
    • "Wind-sock" extension of sinus from body and/or apex of otherwise normal aortic sinus when ruptured
    • Lack of associated lesions such as ventricular septal defect
  • Three-dimensional TTE is becoming a valuable tool for prompt bedside diagnosis of SVA, especially in ruptured situations.

Other Tests

Electrocardiogram usually presents with sinus tachycardia, although conduction defects may occur.

Procedures

Although rarely necessary, the definitive diagnosis can be confirmed by performing a retrograde thoracic aortography or cardiac catheterization. Left-to-right shunting also can be demonstrated if SVA is ruptured.

More on Sinus of Valsalva Aneurysm

Overview: Sinus of Valsalva Aneurysm
Differential Diagnoses & Workup: Sinus of Valsalva Aneurysm
Treatment & Medication: Sinus of Valsalva Aneurysm
Follow-up: Sinus of Valsalva Aneurysm
References
Further Reading
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References

  1. Ring WS. Congenital Heart Surgery Nomenclature and Database Project: Aortic Aneurysm, Sinus of Valsalva Aneurysm, and Aortic Dissection. Ann Thorac Surg. 2000;69:S147-S163. [Medline].

  2. 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. Jul 1998;11(7):729-45. [Medline].

  3. Wang KY, St John Sutton M, Ho HY, Ting CT. Congenital sinus of Valsalva aneurysm: a multiplane transesophageal echocardiographic experience. J Am Soc Echocardiogr. Nov-Dec 1997;10(9):956-63. [Medline].

  4. Prian GW, Diethrich EB. Sinus of Valsalva abnormalities. A specific differentiation between aneurysms of an aneurysms involving the sinuses of Valsalva. Vasc Surg. May-Jun 1973;7(3):155-64. [Medline].

  5. Chu SH, Hung CR, How SS, Chang H, Wang SS, Tsai CH, et al. Ruptured aneurysms of the sinus of Valsalva in Oriental patients. J Thorac Cardiovasc Surg. Feb 1990;99(2):288-98. [Medline].

  6. Moustafa S, Mookadam F, Cooper L, Adam G, Zehr K, Stulak J, et al. Sinus of Valsalva aneurysms--47 years of a single center experience and systematic overview of published reports. Am J Cardiol. Apr 2007;99:1159-64. [Medline].

  7. Ferreira AC, de Marchena E, Mayor M, Bolooki H. Sinus of Valsalva aneurysm presenting as myocardial infarction during dobutamine stress test. Cathet Cardiovasc Diagn. Dec 1996;39(4):400-2. [Medline].

  8. Shahrabani RM, Jairaj PS. Unruptured aneurysm of the sinus of Valsalva: a potential source of cerebrovascular embolism. Br Heart J. Mar 1993;69(3):266-7. [Medline].

  9. 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. Sep-Oct 1991;4(5):485-90. [Medline].

  10. Dev V, Goswami KC, Shrivastava S, Bahl VK, Saxena A. Echocardiographic diagnosis of aneurysm of the sinus of Valsalva. Am Heart J. Oct 1993;126(4):930-6. [Medline].

  11. Fedson S, Jolly N, Lang RM, Hijazi ZM. Percutaneous closure of a ruptured sinus of Valsalva aneurysm using the Amplatzer Duct Occluder. Catheter Cardiovasc Interv. Mar 2003;58(3):406-11. [Medline].

  12. Flynn MS, Castello R, McBride LW, Labovitz AJ. Ruptured congenital aneurysm of the sinus of Valsalva with persistent left superior vena cava imaged by intraoperative transesophageal echocardiography. Am Heart J. Apr 1993;125(4):1185-7. [Medline].

  13. Mayer ED, Ruffmann K, Saggau W, Butzmann B, Bernhardt-Mayer K, Schatton N. Ruptured aneurysms of the sinus of Valsalva. Ann Thorac Surg. Jul 1986;42(1):81-5. [Medline].

  14. Takach TJ, Reul GJ, Duncan JM, et al. Sinus of Valsalva aneurysm or fistula: management and outcome. Ann Thorac Surg. 1999;68(5):1573-7. [Medline].

  15. Harkness JR, Fitton TP, Barreiro CJ, et al. A 32-year experience with surgical repair of sinus of valsalva aneurysms. J Card Surg. Mar-Apr 2005;20(2):198-204. [Medline].

  16. Zikri MA, Stewart RW, Cosgrove DM. Surgical correction for sinus of Valsalva aneurysm. J Cardiovasc Surg (Torino). 1999;40(6):787-91. [Medline].

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Further Reading

Moustafa S, Mookadam F, Cooper L, Adam G, Zehr K, Stulak J, et al. Sinus of Valsalva aneurysms--47 years of a single center experience and systematic overview of published reports. Am J Cardiol. Apr 2007;99:1159-64. [Medline].

Ring WS. Congenital Heart Surgery Nomenclature and Database Project: Aortic Aneurysm, Sinus of Valsalva Aneurysm, and Aortic Dissection. Ann Thorac Surg. 2000;69:S147-S163. [Medline].

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Keywords

sinus of Valsalva aneurysm, SVA, Marfan syndrome, supracristal perimembranous ventricular septal defect, perimembranous ventricular septal defect, bicuspid aortic valve, aortic regurgitation, pulmonary stenosis, coarctation, atrial septal defects, Gerbode defect, cardiac tamponade, aortic media, annulus fibrosus, atherosclerotic aneurysm, syphilis, endocarditis, cystic medial necrosis, chest trauma, deficiency of normal elastic tissue, abnormal development of the bulbus cordis, heart failure syndrome, infective endocarditis, atherosclerosis, ventricular septal defect, aortic insufficiency, coarctation

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Contributor Information and Disclosures

Author

Wai Hong Wilson Tang, MD, Assistant 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, Heart Failure Society of America, and International Society for Heart and Lung Transplantation
Disclosure: Nothing to disclose.

Coauthor(s)

William J Stewart, MD, Associate Professor, Department of Cardiology, The Cleveland Clinic Foundation and Ohio State University
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.

Medical Editor

Alan D Forker, MD, Professor of Medicine, Program Director of Cardiovascular Fellowship, University of Missouri at Kansas City School of Medicine; Director, Outpatient Lipid Diabetes Research Center, MidAmerica Heart Institute of St Luke's Hospital
Alan D Forker, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, American Society of Hypertension, and Phi Beta Kappa
Disclosure: Research Grant Grant/research funds Hospital contracts to do research; I am a hospital employee with no personal profit; Speakers Bureau Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Steven J Compton, MD, FACC, FACP, Director of Cardiac Electrophysiology, Alaska Heart Institute, Providence and Alaska Regional Hospitals
Steven J Compton, MD, FACC, FACP is a member of the following medical societies: Alaska State Medical Association, American College of Cardiology, American College of Physicians, and Heart Rhythm Society
Disclosure: Nothing to disclose.

CME Editor

Amer Suleman, MD, Consultant in Electrophysiology and Cardiovascular Medicine, Department of Internal Medicine, Division of Cardiology, Medical City Dallas Hospital
Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions
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.

 
 
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