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Sinus of Valsalva Aneurysm Workup

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

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.[3, 8]

Two-dimensional transthoracic echocardiography (TTE) may detect as many as 75% of all patients with SVA.[11, 12] Color-flow Doppler imaging is considered the technique of choice for identifying a ruptured SVA. However, the use of contrast echocardiography is helpful in delineating the aneurysm and shunt arising from rupture. The presence of a left-to-right shunt can be confirmed by demonstrating a negative contrast image in the right-sided cavities. 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
  • Detection of associated defects including ventricular septal defect, bicuspid aortic valve, and aortic insufficiency

Three-dimensional TTE is becoming a valuable tool for prompt bedside diagnosis of SVA, especially in ruptured situations. Three-dimensional TEE is useful to determine the precise shape, size, and location of the defect and help guide percutaneous closure device placement.[13]

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

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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.

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Contributor Information and Disclosures
Author

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.

Coauthor(s)

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.

Acknowledgements

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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