Aneurysm of sinus of valsalva (patient information)

	Aneurysm of sinus of valsalva (patient information);
	Aorta laid open to show the semilunar valves. (Aortic sinus, also known as "sinus of Valsalva", is labeled at upper right.)
ICD-10	Q25.4; (EUROCAT Q25.43)
DiseasesDB	32260
eMedicine	med/2133 ped/2106

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editors-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Keri Shafer, M.D. [3]; Priyamvada Singh, MBBS [[4]]

Assistant Editor-In-Chief: Kristin Feeney, B.S. [[5]]

Overview

'Aneurysm of the aortic sinus', also known as the sinus of Valsalva, is comparatively rare, occurring in about one person in every thousand.

When present, it is usually in either the right (65-85%) or in the noncoronary (10-30%) sinus, rarely in the left (< 5%) sinus. This type of aneurysm is typically congenital and may be associated with heart defects.

It is sometimes associated with Marfan syndrome or Loeys-Dietz syndrome, but may also result from Ehlers-Danlos syndrome, atherosclerosis, syphilis, cystic medial necrosis, chest injury, or infective endocarditis.

If unruptured, this type aneurysm may be asymptomatic and therefore go undetected until symptoms appear or medical imaging is performed for other reasons.

Treatment

Medical therapy of aneurysm of the aortic sinus includes blood pressure control through the use of drugs, such as beta blockers. The definitive treatment is surgical repair.

The determination to perform surgery is usually based upon the diameter of the aortic root and the rate of increase in its size, as determined through repeated echocardiography.

Echocardiography

Windsock pattern: Mitral Valve Left Atrium into Left Ventricular Outflow Tract 1

Windsock pattern: Mitral Valve Left Atrium into Left Ventricular Outflow Tract 2

Windsock pattern: Mitral Valve Left Atrium into Left Ventricular Outflow Tract 3

Windsock pattern: Mitral Valve Left Atrium into Left Ventricular Outflow Tract 4

Pathomorphological Images

Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

Sinus of Valsalva Aneurysm: Gross; a beautiful picture of windsock opening of aneurysm beneath anterior leaflet of tricuspid valve into right ventricle
Sinus of Valsalva Aneurysm: Gross; an excellent picture; cut through aneurysm.
Sinus of Valsalva Aneurysm: Gross; An infected aneurysm with a ruptured aortic cusp due to endocarditis.

Sinus of Valsalva Aneurysm: Gross; difficult to orient but aneurysm is visible.
Sinus of Valsalva Aneurysm Infected: Gross; natural color, close-up view of coronary cusps with extensive ulceration and fibrinous material. Staphylococcus infection of a bicuspid valve.
Sinus of Valsalva Aneurysm Infected: Gross; natural color fibrin exudate and some valve scarring are easily seen but aneurysm not seen. The bicuspid valve requires careful look to appreciate Staphylococcus caused lesion.

Ruptured Sinus of Valsalva Aneurysm: Gross; natural color view from left atrium of left sinus aneurysm that is pointing into left atrium through mitral ring at anterior mitral commissure (the most unusual lesion).
Ruptured Sinus of Valsalva Aneurysm: Gross; natural color view of left ventricular outlet with hemorrhagic lesion in left coronary sinus.
Ruptured Sinus of Valsalva Aneurysm: Gross; natural color close-up of aneurysm in aortic valve.

Sinus of Valsalva Aneurysm: Gross fixed tissue shows aneurysm in noncoronary cusp about as well as possible see for picture with probe in aneurysm
Sinus of Valsalva Aneurysm: Gross fixed tissue close-up view with probe in non coronary sinus aneurysm see for photo without probe
Sinus of Valsalva Aneurysm Ruptured: Gross fixed tissue view of right side of heart showing site of rupture below tricuspid ring also patent foramen ovale

Complications

Ruptured Sinus of Valsalva Aneurysm

Ruptured Sinus of Valsalva Aneurysm 1

Ruptured Sinus of Valsalva Aneurysm 2

Ruptured Sinus of Valsalva Aneurysm 3

Ruptured Sinus of Valsalva Aneurysm 4

Ruptured Sinus of Valsalva Aneurysm 5

Ruptured Sinus of Valsalva Aneurysm 6

Ruptured Sinus of Valsalva Aneurysm 7

Additional Resources

Brabram KR, Roberts WC. Fatal intrapericardial rupture of sinus of valsalva aneurysm. Am Heart J 1990; 120 (6 Pt 1): 1455-6.
Edwards JE, Burchell HB. The pathological anatomy of the deficiencies between the aortic root and the heart including aortic sinus aneurysms. Thorax 1957; 12: 125-39.
Tesler UF, Fiorilli R, Lisanti P. Repair of a ruptured sinus of valsalva aneurysm associated with annulo-aortic ectasia and coarctation of the aorta in a patient with Marfan s syndrome. Tex Heart Inst J 1997; 24 (2): 134-8.
Koh KK, Lee KH, Kim SS, Lee SC, Jin SH, Cho SW. Ruptured aneurysm of the sinus of valsalva in a patient with Behcet s disease. Int J Cardiol 1994; 47 (2): 177-9.
Hurley J, McGovern E. Rupture of a sinus of valsalva aneurysm due to aspergillus endocarditis. J Cardiovasc Surg (Torino) 1994; 35 (1): 75-7.
Bansal RC, Wangsnes KM, Bailey L. Right aortic sinus of valsalva to right ventricle fistula complicating bacterial endocarditis of membranous ventricular septal defect. J Am Soc Echocardiogr 1993; 6 (3 Pt 1): 308-11.
Murral EG, Minami K, Kortke H, Seggewiss H, Korfer R. Traumatic sinus of valsalva fistula and aortic valve rupture. Ann Thorac Surg 1993; 55 (3): 760-1.
Cooperberg P, Mercier EN, Mulder D, Winsberg GF. Rupture of a sinus of valsalva aneurysm. Report of a case diagnosed pre-operatively by echocardiography. Radiology 1974; 113: 171-2.
Wang KY, St John Sutton M, Ho HY, Ting CT. Congenital sinus of valsalva aneurysm: a multiplane transoesophageal experience. J Am Soc Echocardiogr 1997; 10 (9): 956-63.
Kulan K, Kulan C, Tuncer C, Komsuoglu, B, Zengin M. Echocardiography and magnetic resonance imaging of sinus of valsalva aneurysm with rupture into the ventricle. J Cardiovasc Surg (Torino) 1996; 37 (6): 639-41.
Sakakibara S, Konno S. Congenital aneurysm of the sinus of valsalva: anatomy and classification. Am Heart J 1962; 63: 405-24.
Dev V, Goswami KC, Shrivastava S, Bahl VK, Saxena A. Echocardiographic diagnosis of aneurysm of the sinus of valsalva. Am Heart J 1993; 126 (4): 930-36.
Isomura T, Hisatomi K, Hirano A, Satho T, Kosuga K, Ohishi K. Ruptured aneurysms of the sinus of valsalva. J Cardiovasc Surg (Torino) 1994; 35 (2): 135-8.
Lukacs L, Bartek I, Haan A, Hankoczy J, Arvay A. Ruptured aneurysms of the sinus of valsalva. Eur J Cardiothorac Surg 1992; 6 (1): 15-7.
Van Son JA, Danielson GK, Schaff HV, Orszulak TA, Edwards WD, Seward JB. Long term outcome of surgical repair of ruptured sinus of valsalva. Circulation 1994; 90 (5 Pt 2): II20-9.
Jeyamalar R, Kannan P. Ruptured aneurysms of the sinus of valsalva. Med J Malaya 1991; 46 (4): 371-5.

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v t e Congenital malformations and deformations of circulatory system (Q20-Q28, 745-747)
Cardiac chambers and connections	Persistent truncus arteriosus - Double outlet right ventricle (Taussig-Bing syndrome) - Transposition of the great vessels (dextro, levo)
Cardiac septa	Ventricular septal defect - Atrial septal defect (Lutembacher's syndrome) - Atrioventricular septal defect (Ostium primum) - Tetralogy of Fallot - Eisenmenger's syndrome
Right: pulmonary and tricuspid valves	pulmonary valves (stenosis, insufficiency) - tricuspid valves (stenosis, atresia) - Ebstein's anomaly
Left: aortic and mitral valves	aortic valves (stenosis, insufficiency, bicuspid) - mitral valves (stenosis, regurgitation) - Hypoplastic left heart syndrome
Other congenital malformations of heart	Dextrocardia - Levocardia - Cor triatriatum
Great arteries	aorta (Patent ductus arteriosus, Aortic coarctation, Interrupted aortic arch, Overriding aorta, Aneurysm of sinus of Valsalva, Vascular ring) - Pulmonary atresia
Great veins	Persistent left superior vena cava - Total anomalous pulmonary venous connection - Scimitar syndrome
Other	Arteriovenous malformation (Cerebral arteriovenous malformation)
See also non-congenital conditions (I, 390-459)