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

Sinus of Valsalva Aneurysm: Follow-up

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

Follow-up

Further Outpatient Care

  • Regularly follow-up with patients with sinus of Valsalva aneurysm who have not undergone surgical repair using echocardiography or MRI to document the size of an unruptured sinus of Valsalva aneurysm.
  • Early rupture can be detected using color Doppler echocardiography or real-time MRI.

Deterrence/Prevention

  • Because the genetic mutation that causes the sinus of Valsalva aneurysm is presumed to be spontaneous, no preventive measures are available. With careful follow-up monitoring of an unruptured sinus of Valsalva aneurysm, complications of rupture and infective endocarditis can be avoided.

Complications

  • Congestive heart failure with acute or progressive rupture or with aortic valve insufficiency
  • Infective endocarditis (possibly associated with smaller ruptured aneurysms in 5-10% of patients)20
  • Angina and myocardial ischemia
  • Heart block resulting from compression of the conduction system21
  • Aortobronchial fistula or aortopulmonary artery fistula (possible rare complications)
  • Abnormal flow (spontaneous contrast) in a dilated unruptured sinus of Valsalva aneurysm (postulated to be a source for systemic embolization)

Prognosis

  • Prognosis after surgical repair in patients with sinus of Valsalva aneurysm is excellent, particularly if the aortic valve has not been damaged.22  Prognosis in patients with a ruptured aneurysm who have not undergone surgical repair may be poor, with survival beyond 1 year uncommon.6,8,22
  • Prognosis in patients with an unruptured sinus of Valsalva aneurysm is unknown because patients may be entirely asymptomatic.

Patient Education

  • Educate parents of pediatric patients with sinus of Valsalva aneurysm regarding avoidance of contact sports and strenuous activities, especially heavy lifting.
  • For excellent patient education resources, visit eMedicine's Circulatory Problems Center. Also, see eMedicine's patient education article Aortic Aneurysm.

Miscellaneous

Medicolegal Pitfalls

  • Failure to 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.
  • Failure to 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.
  • Failure to investigate any abnormal findings depicted on routine radiographs (eg, those obtained during sports examination), such as cardiomegaly or a dilated aorta
  • Failure to 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.
  • Failure to discourage patients with a sinus of Valsalva aneurysm from participation in contact sports or activities involving vigorous exertion

Special Concerns

  • 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.23
  • 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.
 


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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  2. Magee R. A Cardiac Clinico-Pathological Conference in 1882 an historical vignette. Heart Lung Circ. Sep 2004;13(3):322-5. [Medline].

  3. Braunwald E, ed. Heart Disease: A Textbook of Cardiovascular Medicine. Philadelphia, PA: WB Saunders Co; 1996.

  4. Abad C. Congenital aneurysm of the sinus of Valsalva dissecting into the interventricular septum. Cardiovasc Surg. Oct 1995;3(5):563-4. [Medline].

  5. Fazio G, Zito R, Dioco DD, Mussagy C, et al. Rupture of a left sinus of Valsalva aneurysm into the pulmonary artery. Eur J Echocardiogr. Jun 2006;7(3):230-2. [Medline].

  6. Choudhary SK, Bhan A, Sharma R, et al. Sinus of Valsalva aneurysms: 20 years' experience. J Card Surg. Sep-Oct 1997;12(5):300-8. [Medline].

  7. Dong C, Wu QY, Tang Y. Ruptured sinus of valsalva aneurysm: a Beijing experience. Ann Thorac Surg. Nov 2002;74(5):1621-4. [Medline].

  8. Lin CY, Hong GJ, Lee KC, Tsai YT, Tsai CS. Ruptured congenital sinus of valsalva aneurysms. J Card Surg. Mar-Apr 2004;19(2):99-102. [Medline].

  9. Perloff JK, Child JS. Congenital Heart Disease in Adults. 2nd ed. Philadelphia, PA: WB Saunders Co; 1997.

  10. Perloff JK. The Clinical Recognition of Congenital Heart Disease. 4th ed. Philadelphia, PA: WB Saunders Co; 1994.

  11. Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. Oct 9 2007;116(15):1736-54. [Medline]. [Full Text].

  12. Yacoub MH, Khan H, Stavri G, et al. Anatomic correction of the syndrome of prolapsing right coronary aortic cusp, dilatation of the sinus of Valsalva, and ventricular septal defect. J Thorac Cardiovasc Surg. Feb 1997;113(2):253-60; discussion 261. [Medline].

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

  14. Cullen S, Somerville J, Redington A. Transcatheter closure of a ruptured aneurysm of the sinus of Valsalva. Br Heart J. May 1994;71(5):479-80. [Medline].

  15. Abidin N, Clarke B, Khattar RS. Percutaneous closure of ruptured sinus of Valsalva aneurysm using an Amplatzer occluder device. Heart. Feb 2005;91(2):244. [Medline].

  16. Arora R, Trehan V, Rangasetty UM. Transcatheter closure of ruptured sinus of valsalva aneurysm. J Interv Cardiol. Feb 2004;17(1):53-8. [Medline].

  17. Jean WH, Kang TJ, Liu CM, et al. Transcatheter occlusion of ruptured sinus of Valsalva aneurysm guided by three-dimensional transesophageal echocardiography. J Formos Med Assoc. Dec 2004;103(12):948-51. [Medline].

  18. Rao PS, Bromberg BI, Jureidini SB, Fiore AC. Transcatheter occlusion of ruptured sinus of valsalva aneurysm: innovative use of available technology. Catheter Cardiovasc Interv. Jan 2003;58(1):130-4. [Medline].

  19. Shaddy RE, Tani LY, Gidding SS, et al. Beta-blocker treatment of dilated cardiomyopathy with congestive heart failure in children: a multi-institutional experience. J Heart Lung Transplant. Mar 1999;18(3):269-74. [Medline].

  20. McMahon CJ, Ayres N, Pignatelli RH, et al. Echocardiographic presentations of endocarditis, and risk factors for rupture of a sinus of Valsalva in childhood. Cardiol Young. Apr 2003;13(2):168-72. [Medline].

  21. El Hattaoui M, Charei N, Boumzebra D, Chraibi S, Bennis A. A large aneurysm of a left sinus of Valsalva invading the interventricular septum--a rare cause of syncope. Can J Cardiol. May 2008;24(5):e28-9. [Medline].

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

  23. Pamulapati M, Teague S, Stelzer P, Thadani U. Successful surgical repair of a ruptured aneurysm of the sinus of Valsalva in early pregnancy. Ann Intern Med. Dec 1 1991;115(11):880-2. [Medline].

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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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