Pediatric Sinus of Valsalva Aneurysm Differential Diagnoses

Updated: Mar 09, 2021
  • Author: Syamasundar Rao Patnana, MD; Chief Editor: Howard S Weber, MD, FSCAI  more...
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DDx

Diagnostic Considerations

Carefully assess a child under evaluation for a new heart murmur, especially if a diastolic murmur is discovered. The vast majority of "innocent" murmurs are systolic, and the discovery of a new diastolic murmur warrants further investigation.

Carefully evaluate a complaint of new onset of chest pain, fatigue, or exertional dyspnea, with special attention to examination of the cardiovascular system. Again, the development of a new heart murmur should always prompt an investigation into the cause, particularly if the murmur is diastolic.

Investigate any abnormal findings depicted on routine radiographs (eg, those obtained during sports examination), such as cardiomegaly or a dilated aorta.

Take a careful family history in any child discovered to have an aneurysm of a sinus of Valsalva (ruptured or unruptured). This aneurysm is often difficult to distinguish clinically from Marfan syndrome, particularly if the aneurysm is unruptured.

Discourage patients with a sinus of Valsalva aneurysm from participation in contact sports or activities involving vigorous exertion.

Other conditions to consider

Consider the following conditions when evaluating patients with suspected sinus of Valsalva aneurysm:

  • Traumatic injury to the aortic root (usually from direct chest compression)

  • Tertiary syphilis

  • Acute infective endocarditis: Ruptured sinus of Valsalva aneurysm may be confused with, or precipitated by, acute infective endocarditis (see Pediatric Bacterial Endocarditis and Pediatric Fungal Endocarditis).

Successful pregnancy has been reported in women with ruptured sinus of Valsalva aneurysms with appropriate, careful management of labor and delivery. Surgical repair of ruptured aneurysm during pregnancy has been reported. [19]

The disorder is rare enough in the Western Hemisphere that data on recurrence risk for offspring of mothers or fathers with sinus of Valsalva aneurysm have not been reported.

Differential Diagnoses