Sinus of Valsalva Aneurysm Workup

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

Imaging Studies

Cine magnetic resonance imaging (MRI) is the criterion standard.

Multiplane transesophageal echocardiography (TEE) provides conclusive information regarding SVA and allows precise identification of structural anomalies and shunt locations for perioperative assessment. [3, 8]

Two-dimensional transthoracic echocardiography (TTE) may detect as many as 75% of all patients with SVA. [11, 12] 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 or MRI is needed to confirm the diagnosis and for perioperative assessment. Features of TTE include the following:

  • Generalized single sinus enlargement

  • "Wind-sock" extension of sinus from body and/or apex of otherwise normal aortic sinus when ruptured

  • Detection of associated defects including ventricular septal defect, bicuspid aortic valve, and aortic insufficiency

Three-dimensional TTE is becoming a valuable tool for prompt bedside diagnosis of SVA, especially in ruptured situations. Three-dimensional TEE is useful to determine the precise shape, size, and location of the defect and help guide percutaneous closure device placement. [13]

Electrocardiogram usually presents with sinus tachycardia, although conduction defects may occur.

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Procedures

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

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