Laboratory Studies

No specific serologic or genetic markers have been identified for sinus of Valsalva aneurysm.

Serum electrolyte levels are helpful in long-term treatment of heart failure using diuretics, ACE inhibitors, or both.

Imaging Studies

If physical findings are suggestive of a sinus of Valsalva aneurysm, patients may be evaluated using a combination of chest radiography, two-dimensional echocardiography, three-dimensional echocardiography, CT scanning, MRI, and cineangiography.

Echocardiography

Two-dimensional Doppler echocardiograms reveal the proximal aorta, sinuses, aortic valve, and surrounding structures.^[20]See the image below.

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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Doppler findings may provide an accurate indication of the shunt location and magnitude. Three-dimensional echocardiography may be helpful in the planning of appropriate surgical or transcatheter approach.

Echocardiography may be helpful in evaluating adolescent and adult patients with supracristal ventricular septal defects for high-risk features (eg, aneurysm of Valsalva rupture) for surgical planning.^[21]

Transesophageal echocardiography may be required in young adults and adults to optimally depict cardiac structures. Continuous rotation using a multiplanar transducer may be particularly helpful to define the exact point of rupture. Transesophageal echocardiography may be used for more detailed diagnosis of anatomy and blood flow in adult patients.^[22]

Angiography

Coronary angiography can help assess the presence of coronary anomalies or coronary artery compression. Aortic root cineangiography in multiple views may help define the sinus of Valsalva aneurysm, localize the site of rupture and the site into which the aneurysm ruptured. The image below is a selected frame from aortic root cineangiogram demonstrating the aneurysm which ruptured into the right ventricle.

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.

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Radiography

Chest radiography may reveal cardiomegaly. Right heart enlargement is seen with rupture from the aorta into the right ventricle. Rarely, the left side of the aortic root may be enlarged with rupture from the aorta into the left ventricle.

Pulmonary congestion may be depicted in patients with progressive cardiac failure.

Magnetic Resonance Imaging

Magnetic resonance imaging (MRI) can facilitate identification of both a ruptured and an unruptured sinus of Valsalva aneurysm. Cine phase-contrast MRI can be used for assessment of insufficiency and shunt flow.

Black blood studies may be helpful for assessment of ascending aortic flow abnormalities or valve or root morphology.

Other Tests

ECG may reveal biventricular hypertrophy in a patient with a ruptured aneurysm. Myocardial ischemia may be demonstrated by ST-T depression.

Conduction system involvement may be identified by second-degree or third-degree heart block.

Procedures

If physical findings are suggestive of a sinus of Valsalva aneurysm, patients may be evaluated using cardiac catheterization. Cardiac catheterization with coronary and aortic angiography allows quantitation of shunts, cardiac outputs, and hemodynamics.

Histologic Findings

Histologic examination of aortic tissue may reveal medial degeneration.

Treatment & Management

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Media Gallery

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).
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.
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.