Pediatric Sinus of Valsalva Aneurysm Follow-up

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

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.

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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.

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Complications

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) [27]
  • Angina and myocardial ischemia
  • Heart block resulting from compression of the conduction system [28]
  • 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)
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Prognosis

Prognosis after surgical repair in patients with sinus of Valsalva aneurysm is excellent, particularly if the aortic valve has not been damaged.[29] 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.[30] 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.[30]

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Patient Education

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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Contributor Information and Disclosures
Author

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.

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, 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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