Sinus of Valsalva Aneurysm Clinical Presentation

Updated: Jul 15, 2014
  • Author: Anuradha Tunuguntla, MD, FACC; Chief Editor: Park W Willis IV, MD  more...
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Presentation

History

Approximately 25% of reported cases of sinus of Valsalva aneurysm (SVA) are clinically asymptomatic, unruptured SVA detected by routine 2-dimensional echocardiography. Rupture of the aneurysmal sac may occur spontaneously, precipitated by exertion, trauma, or cardiac catheterization.

A ruptured SVA progresses in 3 stages as described by Blackshear and colleagues, as follows: [8]

  • Acute chest or right upper quadrant pain

  • Subacute dyspnea on exertion or at rest (heart failure syndrome) with progressive or acute onset

  • Progressive cough, dyspnea, edema, and oliguria

Atypically, SVA presents with infective endocarditis, which may originate at the edges of the aneurysm.

Palpitations or syncope may present secondary to obstruction of the left or right ventricular outflow tract.

Dyspnea is by far the most common presenting symptom.

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Physical

Unruptured SVA is often asymptomatic and has almost no physical signs. When SVA ruptures, few specific signs of left-to-right shunting may become apparent, and these are often indistinguishable from coronary arteriovenous fistula. Clinical suspicion followed by prompt echocardiographic confirmation is key to diagnosis.

Signs include the following:

  • A loud, superficial, "machine-type" continuous murmur is accentuated in diastole in as many as 40% of patients.

  • A palpable thrill along the right or left lower parasternal border is occasionally noticeable.

  • Bounding pulses are occasionally present.

  • In one series, approximately 44% of the patients had associated aortic regurgitation. [7]

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Causes

Primary causes are congenital.

Secondary causes include the following:

  • Atherosclerosis

  • Syphilis

  • Cystic medial necrosis or Marfan syndrome

  • Blunt or penetrating chest injury

  • Infective endocarditis

Associated congenital defects include the following:

  • Ventricular septal defect

  • Aortic insufficiency

  • Coarctation

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