Sinus of Valsalva Aneurysm Workup

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

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.

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Procedures

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.

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