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Pediatric Sinus of Valsalva Aneurysm Workup

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

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.

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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, CT scanning, MRI, and chest radiography.

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Echocardiography

Two-dimensional Doppler echocardiograms reveal the proximal aorta, sinuses, aortic valve, and surrounding structures.[12] 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.

Echocardiography may be helpful in evaluating adolescent and adult patients with supracristal ventricular septal defects for high-risk features (eg, aneurysm of Valsalva rupture) for surgical planning.[13]

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.[14]

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Angiography

Coronary angiography can help assess the presence of coronary anomalies or coronary artery compression.

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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.

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Magnetic Resonance Imaging

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.

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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.

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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.

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Histologic Findings

Histologic examination of aortic tissue may reveal medial degeneration.

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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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