Pediatric Sinus of Valsalva Aneurysm Differential Diagnoses

  • Author: Edward J Bayne, MD; Chief Editor: Howard S Weber, MD, FSCAI  more...
Updated: Feb 06, 2015

Diagnostic Considerations

Carefully assess a child under evaluation for a new heart murmur, especially if a diastolic murmur is discovered: The vast majority of "innocent" murmurs are systolic, and the discovery of a new diastolic murmur warrants further investigation.

Carefully evaluate a complaint of new onset of chest pain, fatigue, or exertional dyspnea, with special attention to examination of the cardiovascular system: Again, the development of a new heart murmur should always prompt an investigation into the cause, particularly if the murmur is diastolic.

Investigate any abnormal findings depicted on routine radiographs (eg, those obtained during sports examination), such as cardiomegaly or a dilated aorta.

Take a careful family history in any child discovered to have an aneurysm of a sinus of Valsalva (ruptured or unruptured): This aneurysm is often difficult to distinguish clinically from Marfan syndrome, particularly if the aneurysm is unruptured.

Discourage patients with a sinus of Valsalva aneurysm from participation in contact sports or activities involving vigorous exertion

Other conditions to consider

When evaluating patients with suspected sinus of Valsalva aneurysm consider the following conditions:

  • 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).

Successful pregnancy has been reported in women with ruptured sinus of Valsalva aneurysms with appropriate, careful management of labor and delivery. Surgical repair of ruptured aneurysm during pregnancy has been reported.[11]

The disorder is rare enough in the Western Hemisphere that data on recurrence risk for offspring of mothers or fathers with sinus of Valsalva aneurysm have not been reported.

Differential Diagnoses

Contributor Information and Disclosures

Edward J Bayne, MD Assistant Professor, Division of Pediatric Cardiology, Emory University School of Medicine

Edward J Bayne, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society of Echocardiography, American College of Cardiology, American Heart Association

Disclosure: Nothing to disclose.


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, American Society of Echocardiography

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

John W Moore, MD, MPH Professor of Clinical Pediatrics, Section of Pediatic Cardiology, Department of Pediatrics, University of California San Diego School of Medicine; Director of Cardiology, Rady Children's Hospital

John W Moore, MD, MPH is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, Society for Cardiovascular Angiography and Interventions

Disclosure: Nothing to disclose.

Chief Editor

Howard S Weber, MD, FSCAI Professor of Pediatrics, Section of Pediatric Cardiology, Pennsylvania State University College of Medicine; Director of Interventional Pediatric Cardiology, Penn State Hershey Children's Hospital

Howard S Weber, MD, FSCAI is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, Society for Cardiovascular Angiography and Interventions

Disclosure: Received income in an amount equal to or greater than $250 from: St. Jude Medical.

Additional Contributors

Juan Carlos Alejos, MD Clinical Professor, Department of Pediatrics, Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine

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, International Society for Heart and Lung Transplantation

Disclosure: Received honoraria from Actelion for speaking and teaching.

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Sinus of Valsalva aneurysm. Color-flow Doppler ultrasonography is performed in the right ventricle through a supracristal ventricular septal defect with fingerlike prolapse of the right coronary sinus wall (arrow).
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