Aneurysm of sinus of Valsalva
| Aneurysm of sinus of Valsalva | |
|---|---|
| Other names | Aortic sinus aneurysm |
MRI scan | |
| Treatment | Blood pressure control, surgery |
| Medication | Beta-adrenoceptor antagonists |
| Prognosis | Median survival after rupture 3.9 years |
| Frequency | 0.09% |
Aortic sinus aneurysms may occur in isolation, or may be seen in association with other diseases of the aorta including Marfan syndrome, Loeys-Dietz syndrome, and bicuspid aortic valve. They can be diagnosed using an echocardiogram or cardiac magnetic resonance imaging (MRI) scan. Treatment includes blood pressure control but surgical repair may be needed, especially if the aneurysm ruptures.
Symptoms and signs
If unruptured, sinus of Valsalva aneurysm (commonly abbreviated SVA or SOVA) is usually asymptomatic and typically goes undetected until symptoms appear or
A ruptured aneurysm typically leads to an aortocardiac shunt and progressively worsening heart failure.[2]
An aneurysm of the aortic sinus may rupture due to infective endocarditis involving the aortic wall and tertiary-stage syphilis.[citation needed]
The manifestations appear depending on the site where the sinus has ruptured. For example, if the sinus ruptures in a low pressure area like the right atrium or right ventricle then a continuous type of murmur is heard. The murmur is located in the left parasternal region mainly confined to the lower sternum. It is also accompanied by a superficial thrill. A ruptured Sinus of Valsalva abscess represents a surgical emergency.[citation needed]
Causes
This type of aneurysm is typically
Diagnosis
The first step in diagnosis is typically transthoracic echocardiography. However, if surgery is planned or if the standard echocardiogram lacks sufficient detail, then one or more additional studies are recommended. These studies include transesophageal echocardiography, 3D echocardiography, CT Angiography and aortic angiography.[4] Cardiac MRI may be another option.[2]
Treatment
Medical therapy of
Another approach is surgical repair.[5] The determination to perform surgery is usually based upon the diameter of the aortic root (with 5 centimeters being a rule of thumb - a normal size is 2-3 centimeters) and the rate of increase in its size (as determined through repeated echocardiography).[citation needed]
An alternative to surgical repair or a ruptured aneurysm is percutaneous closure.[6] In this technique, a wire is introduced via a small incision in the groin and advanced through the vascular system to the aneurysm. A closure device is advanced along the wire before being expanded to straddle the site of rupture.[7]
Prognosis
If a sinus of Valsalva aneurysm ruptures, the life expectancy without treatment is approximately four years.[8] Surgery carries a 1% risk of intra-operative death with higher risks associated with infected aneurysms, and 5- to 10-year survival rates following surgery range from 82 to 97%.[8]
Epidemiology
Aneurysms of the sinuses of Valsalva are estimated to affect 0.09% of the population.[8] Rupture of a sinus of Valsalva can occur at any age.[8] Rupture is five times more likely to occur in those of far eastern than western ethnic backgrounds, and is twice as likely to occur in males than females.[8]
History
The first description of sinus of Valsalva aneurysm was made in 1939.[9][8]
See also
References
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- ^ PMID 28814376.
- PMID 25757442.
- PMID 28291779.
- PMID 11423277.
- PMID 28814376.
- S2CID 24898261.
- ^ PMID 16638563.
- ^ Hope, James (1839). A treatise on the diseases of the heart and great vessels, and on the affections that may be mistaken for them: comprising the author's view of the physiology of the heart's actions and sounds, as demonstrated by his experiments on the motions and sounds. Oxford University.