Sinus of Valsalva Aneurysms

Abstract

Sinus of Valsalva aneurysms are rare but important entities. They are predominantly congenital in origin resulting from incomplete fusion of the aortic media and the aortic valve annulus. Less frequently, they may be acquired, usually secondary to infective endocarditis. Unruptured aneurysms may be clinically silent and diagnosed incidentally, or produce symptoms secondary to mass effect on related structures. Rupture of the sinus, with a resultant large left-to-right shunt, and severe congestive heart failure can be a life-threatening situation. Early diagnosis is crucial and can usually be made reliably by transthoracic echocardiography. However, transesophageal echocardiography may sometimes be required for confirmation. Cardiovascular magnetic resonance imaging and multi-detector computed tomography are being increasingly utilized for evaluation of sinus of Valsalva and can offer valuable complimentary information. Surgical repair is the predominant mode of treatment for both ruptured and unruptured aneurysms and has low complication rates. In recent years transcatheter techniques have emerged as a nonsurgical option for repair. This chapter provides an overview of the pathological and clinical aspects of sinus of Valsalva aneurysms and focuses on the treatment modalities.