Medication Summary
No specific medical therapy is indicated for sinus of Valsalva aneurysm. Treatment of congestive heart failure may be required if rupture of the aneurysm occurs into the right heart chambers; standard therapy for heart failure is recommended, [3, 46] although surgery is the treatment of choice.
Angiotensin-converting enzyme (ACE) inhibitors
Class Summary
Chronic rupture of a sinus of Valsalva aneurysm may produce protracted symptoms and findings of congestive heart failure. ACE inhibitors and angiotensin receptor blockers (ARB) have been shown to be effective in the treatment of long-standing aortic insufficiency. ACE inhibitors and ARBs are beneficial in all stages of chronic heart failure. Pharmacologic effects provide both preload and afterload reduction and may have beneficial effects in the prevention of pathologic hypertrophy from volume overload.
Captopril (Capoten)
Prevents conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, resulting in lower aldosterone secretion.
Note: May be placed into stabilized suspension with water and ascorbic acid.
Lisinopril (Prinivil, Zestril)
Prevents conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, resulting in lower aldosterone secretion.
Cardiac glycosides
Class Summary
Digitalis remains useful in the treatment of chronic heart failure. Cardiac glycosides are positive inotropic agents that increase the force of contraction of the myocardium and are used to treat acute and chronic congestive heart failure. Cardiac glycosides have been implicated in improving chemoreceptor function, thus potentially increasing exercise tolerance in patients with heart failure.
Digoxin (Lanoxin, Lanoxicaps)
Useful in slowing and stabilizing heart rate, particularly at the atrioventricular node. Acts directly on cardiac muscle, increasing myocardial systolic contractions. Indirect actions result in increased carotid sinus nerve activity and enhanced sympathetic withdrawal for any given increase in mean arterial pressure.
Diuretic agents
Class Summary
These agents promote excretion of water and electrolytes by the kidneys and are used to treat heart failure or hepatic, renal, or pulmonary disease when sodium and water retention have resulted in edema or ascites. Both oral and parenteral diuretics may be helpful in the management of congestive heart failure.
Furosemide (Lasix)
Loop diuretic that increases excretion of water by interfering with chloride-binding cotransport system, which, in turn, inhibits sodium and chloride reabsorption in the ascending loop of Henle and distal renal tubules.
Used commonly for acute and long-term management of congestive heart failure.
Hydrochlorothiazide (HydroDIURIL, Microzide)
Inhibits reabsorption of sodium in distal tubules, causing increased excretion of sodium and water, as well as potassium and hydrogen ions.
Spironolactone (Aldactone)
Competes with aldosterone for receptor sites in distal renal tubules, increasing water excretion while retaining potassium and hydrogen ions. Has positive effect on neurohumoral mechanisms in congestive heart failure and may be helpful in remodeling in pathologic hypertrophy.
Beta-adrenergic receptor blockers
Class Summary
These agents inhibit chronotropic, inotropic, and vasodilatory responses to beta-adrenergic stimulation. They are used for their effect on reducing myocardial oxygen consumption in congestive heart failure. Beta-blockers also counteract the sympathetic overdrive of congestive heart failure.
Metoprolol (Lopressor)
Selective beta1-adrenergic receptor blocker that decreases automaticity of contractions.
Carvedilol (Coreg)
Blocks beta1-adrenergic, alpha-adrenergic, and beta2-adrenergic receptor sites. Recently introduced to treat congestive heart failure. Therapeutic trials are currently underway in pediatric patients in the United States.
Nitrates
Class Summary
Nitrates are peripheral and coronary vasodilators used in the management of angina pectoris, heart failure, and myocardial infarction. When given orally or sublingual, these agents reduce preload and improve myocardial oxygen supply and demand.
Nitroglycerin sublingual (Nitrostat)
Causes relaxation of vascular smooth muscle by stimulating intracellular cyclic guanosine monophosphate production. Administered acutely or in SR preparations for relief of myocardial ischemia and for reduction of preload and afterload. PO/SL forms rarely are administered in infants or children.
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Sinus of Valsalva aneurysm. Color-flow Doppler ultrasonography is performed in the right ventricle through a supracristal ventricular septal defect with fingerlike prolapse of the right coronary sinus wall (arrow).
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Sinus of Valsalva aneurysm. Apical four chamber (left) and precordial short axis (right) views demonstrating aneurysm (ANU) of the sinus of Valsalva protruding from the aorta (Ao). LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle; TV, tricuspid valve.
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Sinus of Valsalva aneurysm. Selected frame from aortic (Ao) root cineangiography following coil occlusion demonstrating complete ablation of the shunt. ANU, aneurysm; R, rupture; RV, right ventricle.
