Pediatric Sinus of Valsalva Aneurysm Follow-up
- Author: Edward J Bayne, MD; Chief Editor: Howard S Weber, MD, FSCAI more...
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.
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.
The following complications may arise in patients with sinus of Valsalva aneurysm:
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) 
Angina and myocardial ischemia
Heart block resulting from compression of the conduction system 
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 after surgical repair in patients with sinus of Valsalva aneurysm is excellent, particularly if the aortic valve has not been damaged. Prognosis in patients with a ruptured aneurysm who have not undergone surgical repair may be poor, with survival beyond 1 year uncommon.[6, 8, 29]
Prognosis in patients with an unruptured sinus of Valsalva aneurysm is unknown because patients may be entirely asymptomatic.
In a retrospective review of 255 Chinese patients who underwent surgical repair of congenital sinus of Valsava aneurysm over a 7-year period, investigators indicated good outcomes, but the presence of aortic regurgitation at discharge is an independent risk factor for exacerbation of aortic regurgitation at late follow-up. The origin of the aneurysm in 212 patients (83.1%) was the right sinus, and in 38 patients (14.9%), it was the noncoronary sinus. Of 142 patients (55.7%) who had aortic regurgitation, 60 received aortic valve replacement and 13 received aortic valvuloplasty. Three of the valvuloplasties failed and the affected patients underwent aortic valve replacement.
Risk factors for aortic valve regurgitation included the presence of infective endocarditis, the presence of a nonruptured sinus of Valsalva aneurysm, and the cardiothoracic ratio. There were no early deaths reported, but there were two late deaths and two patients with complications associated with anticoagulation. Of 150 patients who had late follow-up, echocardiography showed 17 had improvement of aortic regurgitation, whereas progression occurred in 20.
Educate parents of pediatric patients with sinus of Valsalva aneurysm regarding avoidance of contact sports and strenuous activities, especially heavy lifting.
For patient education resources, see Aortic Aneurysm.
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