Sinus of Valsalva Aneurysm Workup

Updated: Dec 14, 2020
  • Author: Arnold S Baas, MD, FACC, FACP; Chief Editor: Yasmine S Ali, MD, MSCI, FACC, FACP  more...
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Imaging Studies

Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) have traditionally been used to diagnose sinus of Valsalva aneurysm (SVA), but electrocardiography (ECG)-gated computed tomographic angiography (CTA) and cardiac magnetic resoance imaging (CMRI) have gained popularity in recent decades. [2, 17]

Multiplane TEE provides conclusive information regarding SVA and allows precise identification of structural anomalies and shunt locations for perioperative assessment. [3, 14]

Two-dimensional TTE may detect as many as 75% of all patients with SVA. [18, 19] Color-flow Doppler imaging is considered the technique of choice for identifying a ruptured SVA. However, the use of contrast echocardiography is helpful in delineating the aneurysm and shunt arising from rupture. The presence of a left-to-right shunt can be confirmed by demonstrating a negative contrast image in the right-sided cavities. Usually TEE, EGG-gated CTA, or CMRI is needed to confirm the diagnosis and for perioperative assessment.

Features of SVA on TTE include the following:

  • Generalized single sinus enlargement
  • "Wind-sock" extension of the sinus from the body and/or apex of an otherwise normal aortic sinus when ruptured
  • Detection of associated defects, including ventricular septal defect, bicuspid aortic valve, and aortic insufficiency

ECG-gated CTA and CMRI may provide valuable three-dimensional data for procedural planning.

Electrocardiography usually reveals sinus tachycardia, although conduction defects may occur.



Although rarely necessary, the definitive diagnosis of sinus of Valsalva aneurysm can be confirmed by performing a retrograde thoracic aortography or cardiac catheterization. Left-to-right shunting also can be demonstrated if the SVA is ruptured.