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.

Causes

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
  • atherosclerosis
  • injury
Location

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.

Cardiac MRI/CT

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.

Surgical repair with a Bentall procedure could be performed.

Complications
  • rupture
    • most commonly into right ventricle
    • may lead to cardiac tamponade +/- intracardiac shunting
  • ventricular outflow tract obstruction
  • aortic regurgitation
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Article Information

rID: 9984
Systems: Cardiac, Vascular
Section: Pathology
Tag: cases
Synonyms or Alternate Spellings:
  • Sinus of Valsalva aneurysms

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Cases and Figures

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    Case 1: right coronary sinus
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