Surgical management for unruptured sinus of Valsalva aneurysms: a narrative review of the literature

Abstract

Unruptured sinus of Valsalva aneurysms (SVAs) are rare cardiac lesions that arise due to congenital or acquired etiologies. They could be asymptomatic or cause various clinical manifestations as a consequence of their mass effect on the coronary arteries, heart valves, and other adjacent structures. While the factors predicting SVA rupture are not fully understood, ruptured SVAs carry a high complication and mortality rate, highlighting the need for early recognition and management of unruptured SVAs. Imaging modalities such as echocardiography, computed tomography (CT), angiography, and magnetic resonance imaging (MRI) are essential in identifying and characterizing the aneurysm as well as associated cardiac anomalies. However, there are no specific guidelines for the diagnosis and management of SVAs. Herein, we performed a contemporary systematic review to examine the presentation, diagnostic tests and findings, as well as outcomes for surgical intervention of unruptured SVAs. We demonstrate that surgical repair remains the preferred method of treatment in order to prevent complications such as rupture or thrombus formation.Surgery should be prompted in patients with symptomatic, large, or rapidly expanding unruptured SVAs, as well as those unruptured SVAs that contain intraluminal thrombi, have a mass effect on surrounding structures, or are recurrent. Surgical outcomes are generally good with favourable prognosis and minimal recurrence.

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“…SVA are more prevalent in Asian populations and affect predominantly the right coronary sinus. Unruptured SVA are usually asymptomatic or mildly symptomatic, however in rare cases can they present with a heart murmur or signs of right ventricular outflow tract obstruction ( 9 ). Most cases of SVA are recognized after rupture, which typically occurs in early adulthood (13–39 years of age) ( 8 ).…”

Transthoracic minimally invasive closure for the treatment of ruptured sinus of Valsalva aneurysm: immediate and mid-term follow-up results

“…Additionally, it is capable of rapidly and accurately detecting complications related to interventional and surgical repairs (12). Patients with unruptured SVA usually do not have any symptoms, but nearly 80% of patients will have symptoms when the RSVA protrudes into one of the cardiac chambers (13,14). The most common symptoms are dyspnoea, orthopnea, palpitations, fatigability, palpitations, chest pain, and even sudden death (15).…”

To Treat or Not to Treat? This Is the Question… About the Incidental Finding of Double Sinus of Valsalva Aneurysm in A 91-Year-Old Woman

“…When symptomatic, SVA usually present with signs of aortic rupture, angina (due to compression of the coronary artery), cardiac arrhythmias or with symptoms related to the compression of the neighbouring structures. A recent review showed that, as observed in this case, atrial fibrillation was the most reported arrhythmia (9%), while myocardial ischemia was present in only 5 cases among the 53 reported and was related to the high SVA dimensions [ 1 ] . However, the reported review showed that the oldest treated patients that could be found in the literature were 84 years old [ 2 ] .…”

“…Sinus of Valsalva aneurysm (SVA) is an extremely rare finding, affecting about 0.09% of the general population [ 1 ] , and is usually an incidental report. When symptomatic, SVA usually present with signs of aortic rupture, angina (due to compression of the coronary artery), cardiac arrhythmias or with symptoms related to the compression of the neighbouring structures.…”