Sinus of Valsalva aneurysm
Sinus of Valsalva aneurysms are a cause of thoracic aortic dilatation. They can be either congenital or acquired (mycotic).
There is a male predilection (M:F ratio being around 3-4:1). They are relatively more common in eastern and Asian populations and can occur in any age group with a mean age of 35 years at presentation 4.
They may be asymptomatic. Presentation with a catastrophic acute rupture is quite common. Cardiac murmur, dyspnoea, chest pain and palpitations may occur 4.
They can be either congenital or acquired (mycotic). Congenital cases are proposed to result from weakness in the elastic lamina of the wall. Acquired causes include:
- infection: endocarditis, tuberculosis, syphilis
It most often involves the right coronary sinus, less frequently the non-coronary sinus and rarely left coronary sinus 3.
They are saccular and arise above the aortic annulus.
MRI is considered the imaging modality of choice, especially with the mycotic type. Saccular aneurysm is seen arising from one of the sinus (right coronary sinus being the most common location) and protruding into adjacent cardiac chamber.
Treatment and prognosis
Surgical repair with a Bentall procedure could be performed.
- most commonly into right ventricle
- may lead to cardiac tamponade +/- intracardiac shunting
- ventricular outflow tract obstruction
- aortic regurgitation
- 1. Hoey ET, Kanagasingam A, Sivananthan MU. Sinus of valsalva aneurysms: assessment with cardiovascular MRI. AJR Am J Roentgenol. 2010;194 (6): W495-504. doi:10.2214/AJR.09.3570 - Pubmed citation
- 2. Salanitri GC, Huo E, Miller FH et-al. MRI of mycotic sinus of valsalva pseudoaneurysm secondary to Aspergillus pericarditis. AJR Am J Roentgenol. 2005;184 (3): S25-7. AJR Am J Roentgenol (full text) - Pubmed citation
- 3. Fazio G, Zito R, Dioco DD et-al. Rupture of a left sinus of Valsalva aneurysm into the pulmonary artery. Eur J Echocardiogr. 2006;7 (3): 230-2. doi:10.1016/j.euje.2005.11.003 - Pubmed citation
- 4. Bricker AO, Avutu B, Mohammed TL et-al. Valsalva sinus aneurysms: findings at CT and MR imaging. Radiographics. 2010;30 (1): 99-110. doi:10.1148/rg.301095719 - Pubmed citation