The role of multi-modality imaging for sinus of Valsalva aneurysms

Abstract

Sinus of Valsalva aneurysms (SVAs) are uncommon but important entities. They are most often congenital in origin, resulting from incomplete fusion of the aortic media to the aortic valve annulus. Less frequently, they may be acquired, usually secondary to infective endocarditis. Unruptured aneurysms may be clinically silent and diagnosed incidentally, but can also produce symptoms as a consequence of mass effect on related structures. Rupture may present with sudden hemodynamic collapse but can have a more insidious onset depending upon the site and size of the perforation. Early diagnosis is imperative and can usually be made reliably by transthoracic echocardiography. However, transesophageal echocardiography may sometimes be required for confirmation. Cardiovascular magnetic resonance imaging (CMRI) and multi-detector computed tomography are being increasingly utilized for evaluation of SVAs and can offer valuable complimentary information. CMRI in particular enables a comprehensive assessment of anatomy, function and flow in a single sitting. Surgical repair forms the mainstay of treatment for both ruptured and unruptured aneurysms and has low complication rates. This article provides an overview of the pathological and clinical aspects of SVAs and discusses in detail the role of advanced imaging modalities in their evaluation.

Normal values of the mitral-aortic intervalvular fibrosa thickness: A multimodality study

“…[20] TEE is more sensitive than TTE to detect the increased MAIVF thickness, abscess, pseudoaneurysm, and fistulae. [212223] An early recognition of the thickening is of crucial importance, because, as already said, urgent surgical correction is recommended. Our study is the first to provide reference normal values to define an “increased” MAIVF thickness.…”

Spontaneous rupture of sinus of valsalva aneurysm presenting as perivalvular hematoma

“…Transesophageal echocardiogram (TEE) is helpful in delineating small ruptures. [ 5 ] With multiplane transducers, three-dimensional (3D) anatomy is better appreciated which is important for planning surgical repair. [ 5 ] 3D TEE technologies in real time can track catheters and devices and is a useful guide for percutaneous closure.…”

Incidental Finding of an Aorto-Right Atrial Fistula in a Patient Undergoing Repair of a Sinus of Valsalva Aneurysm

“…Both CTA and CMRI offer excellent anatomical depiction of a SOVA and may help identify fistulous tracts (21, 22). The CTA in the case presented, however, did not identify the SOVA to RA fistula due to concomitant opacification of the aorta and the RA by the radiographic contrast.…”