eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Cardiology

Sinus of Valsalva Aneurysm: Differential Diagnoses & Workup

Author: Edward J Bayne, MD, Assistant Professor, Division of Pediatric Cardiology, Emory University School of Medicine; Consulting Staff, Sibley Heart Center Cardiology, Children's Healthcare of Atlanta
Coauthor(s): Lynn Cronin, MD, Clinical Cardiology Fellow, Department of Pediatrics, Division of Cardiology, William Beaumont Hospital
Contributor Information and Disclosures

Updated: Oct 10, 2008

Differential Diagnoses

Aortic Stenosis, Supravalvar
Kawasaki Disease
Aortic Stenosis, Valvar
Marfan Syndrome
Aortic Valve Insufficiency
Osteogenesis Imperfecta
Aortic Valve, Bicuspid
Patent Ductus Arteriosus
Atrioventricular Block, Third Degree, Acquired
Pulmonary Stenosis, Valvar
Coronary Artery Anomalies
Turner Syndrome
Coronary Artery Fistula
Ventricular Septal Defect, Supracristal
Double-Chambered Right Ventricle
Williams Syndrome
Ehlers-Danlos Syndrome

Other Problems to Be Considered

Traumatic injury to the aortic root (usually from direct chest compression)
Tertiary syphilis
Acute infective endocarditis: Ruptured sinus of Valsalva aneurysm may be confused with, or precipitated by, acute infective endocarditis (see Endocarditis, Bacterial, Endocarditis, Fungal).

Workup

Laboratory Studies

  • No specific serologic or genetic markers have been identified for sinus of Valsalva aneurysm.
  • Serum electrolyte levels are helpful in long-term treatment of heart failure using diuretics, ACE inhibitors, or both.

Imaging Studies

If physical findings are suggestive of a sinus of Valsalva aneurysm, patients may be evaluated using a combination of 2-dimensional echocardiography, 3-dimensional echocardiography, MRI, and chest radiography.

  • Echocardiography
    • Two-dimensional Doppler echocardiograms reveal the proximal aorta, sinuses, aortic valve, and surrounding structures. Doppler findings may provide an accurate indication of the shunt location and magnitude. Three-dimensional echocardiography may be helpful in the planning of appropriate surgical or transcatheter approach.
    • Transesophageal echocardiography may be required in young adults and adults to optimally depict cardiac structures. Continuous rotation using a multiplanar transducer may be particularly helpful to define the exact point of rupture. Transesophageal echocardiography may be used for more detailed diagnosis of anatomy and blood flow in adult patients.
  • Angiography: Coronary angiography can help assess the presence of coronary anomalies or coronary artery compression.
  • Radiography
    • Chest radiography may reveal cardiomegaly.
    • Right heart enlargement is seen with rupture from the aorta into the right ventricle. Rarely, the left side of the aortic root may be enlarged with rupture from the aorta into the left ventricle.
    • Pulmonary congestion may be depicted in patients with progressive cardiac failure.
  • MRI
    • MRI can facilitate identification of both a ruptured and an unruptured sinus of Valsalva aneurysm.
    • Cine phase-contrast MRI can be used for assessment of insufficiency and shunt flow.
    • Black blood studies may be helpful for assessment of ascending aortic flow abnormalities or valve or root morphology.

Other Tests

  • ECG may reveal biventricular hypertrophy in a patient with a ruptured aneurysm. Myocardial ischemia may be demonstrated by ST-T depression.
  • Conduction system involvement may be identified by second-degree or third-degree heart block.

Procedures

  • If physical findings are suggestive of a sinus of Valsalva aneurysm, patients may be evaluated using cardiac catheterization. Cardiac catheterization with coronary and aortic angiography allows quantitation of shunts, cardiac outputs, and hemodynamics.

Histologic Findings

  • Histologic examination of aortic tissue may reveal medial degeneration.

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
Multimedia: Sinus of Valsalva Aneurysm
References
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References

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Further Reading

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Keywords

sinus of Valsalva fistula, aortocameral fistula, Valsalva sinus rupture, congenital Valsalva sinus aneurysm, Valsalva sinus fistula, aortic sinus, ruptured Valsalva sinus aneurysm, unruptured Valsalva sinus aneurysm, heart murmur, diastolic murmur, heart failure, Marfan syndrome, syphilitic aortitis, ventricular septal defect, supracristal ventricular septal defect, aortic insufficiency, heart block, subpulmonic ventricular septal defect, cardiac tamponade, dysrhythmia, coronary ischemia, acute myocardial infarction, angina, syncope, Adams-Strokes syndrome, syphilis, Ehlers-Danlos syndrome, Turner syndrome, Williams syndrome, bicuspid aortic valve, osteogenesis imperfecta

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Contributor Information and Disclosures

Author

Edward J Bayne, MD, Assistant Professor, Division of Pediatric Cardiology, Emory University School of Medicine; Consulting Staff, Sibley Heart Center Cardiology, Children's Healthcare of Atlanta
Edward J Bayne, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Cardiology, American Heart Association, and American Society of Echocardiography
Disclosure: Nothing to disclose.

Coauthor(s)

Lynn Cronin, MD, Clinical Cardiology Fellow, Department of Pediatrics, Division of Cardiology, William Beaumont Hospital
Lynn Cronin, MD is a member of the following medical societies: American College of Physicians and American Society of Echocardiography
Disclosure: Nothing to disclose.

Medical Editor

Juan Carlos Alejos, MD, Associate Clinical Professor, Department of Pediatrics, Division of Cardiology, University of California at Los Angeles
Juan Carlos Alejos, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Medical Association, and International Society for Heart and Lung Transplantation
Disclosure: Actelion Honoraria Speaking and teaching

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

John W Moore, MD, MPH, Professor of Clinical Pediatrics, Division of Pediatric Cardiology, Mattel Children's Hospital of University of California at Los Angeles
John W Moore, MD, MPH is a member of the following medical societies: Society for Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

CME Editor

Gilbert Herzberg, MD, Assistant Professor, Department of Pediatrics, Section of Pediatric Cardiology, New York Medical College
Gilbert Herzberg, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Chief Editor

Stuart Berger, MD, Professor of Pediatrics, Division of Cardiology, Medical College of Wisconsin; Chief of Pediatric Cardiology, Medical Director of Pediatric Heart Transplant Program, Medical Director of The Heart Center, Children's Hospital of Wisconsin
Stuart Berger, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American College of Chest Physicians, American Heart Association, and Society for Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

 
 
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