Sinus of Valsalva Aneurysm Treatment & Management

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

Medical Care

Medical management usually involves stabilization (eg, optimizing medications for heart failure syndrome) and perioperative assessment and management. [8]

Transcatheter closure of ruptured sinus of Valsalva aneurysm (SVA) has been successfully performed using Amplatzer devices. [14, 15, 16] Ruptured SVA have been treated with transcatheter closure to avoid sternotomy and cardiopulmonary bypass in critically ill patients.

Although advanced percutaneous techniques have been performed in the correction of this anomaly, open-heart surgery with or without aortic valve replacement remains the treatment of choice.

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Surgical Care

Cardiothoracic surgery consultation is urgent in patients with ruptured SVA, because clinical deterioration can be rapid.

Conventionally, with an operative mortality rate of less than 2%, surgical repair of the ruptured SVA has been the mainstay of therapy. Urgent surgical repair is recommended in all patients with ruptured SVA, especially with intracardiac shunting. [17, 18, 19] Aggressive surgical correction of unruptured SVA is often recommended because of its association with increased morbidity and mortality. [7, 20, 21, 22, 23, 24]

  • Aortic root reconstruction or replacement

  • Aortic valve repair or replacement

  • Bentall procedure (valved conduit)

  • Ventricular septal defect repair (if present)

  • Atrial septal defect repair (if present)

  • Primary suture closures (pledget) and patch closures (if ruptured)

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