Sinus of valsalva aneurysm

Sinus of Valsalva Aneurysm

Pre-post Tricuspid L-R shunt

Memory lane• 1839 -1st description by Hope

• 1840- 1st important paper published by Thurman

• 1949- Jones and Langley -the subject of congenital and acquired lesion

• 1951- 1st diagnosis of rupture during life by Venning

• 1956- 1st. successful repair with CPB at Mayo Clinic using CPB.

• 1957-Morrow & colleagues –closed ruptured SOVA using mild hypothermia

• SAKAKIBARA & KONNO

- Studied association with VSD & AR

- First to provide comprehensive classification

CONGENITAL ACQUIRED

Connective tissue disorders-

• VSD• Rheumatoid arthritis,• Ehlers-Danhlos syndrome, • Marfan’s syndrome, • Klippel Feil syndrome, • Turner’s syndrome, • Trisomies 13 and 15,• Loeys-Dietz syndrome, • Arachnodactyly, • Osteogenesis imperfecta.

• Infectious diseases –

bacterial endocarditis,

syphilis, and tuberculosis;

• Degenerative conditions

atherosclerosis

cystic medial necrosis;

• Injury from deceleration trauma.

• Iatrogenic pseudoaneurysms hematoma formation after AVR

removal of aortic valve calcifcations

Aetiology

Congenital Acquired

• VSD• Rheumatoid arthritis• Ehlers-Danhlos syndrome • Marfan’s syndrome• Klippel Feil syndrome• Turner’s syndrome• Trisomies 13 and 15• Loeys-Dietz syndrome• Arachnodactyly• Osteogenesis imperfecta

• Infectious diseases – bacterial endocarditis, syphilis, and tuberculosis;

• Degenerative conditions atherosclerosis cystic medial necrosis;

• Injury from deceleration trauma.

• Iatrogenic pseudoaneurysms hematoma formation after AVR removal of aortic valve calcifcations

Origin

• RCC:77%• Non-CC:19%• Multiple:2.4%• left coronary sinus:0.5%

Intact vs. rupture

• 71.7% ruptured

Exit

• Most commonly into the right ventricle (67.9%)• Right atrium (27.4%)• Other rare entry sites of rupture included the left atrium, the left

ventricle, the interatrial• septum, the interventricular septum and the pulmonary artery (0.5%–

1.9%)

Sakakibara S, Konno S. Congenital aneurysm of the sinus of Valsalva. Anatomy and classification. Am Heart J 1962;63:405–24.• 47.6% type I• 33.5% type II• 6.1% type IIIv • 12.8% type IIIa

The SVAs arising from RCC by angiogram Sakakibara and Konno

• Type I: left part of the sinus rupture or protrusion into upper portion of RVOT• Type II: central part of the sinus rupture or protrusion into mid-

portion of RVOT through supraventricular crest• Type IIIv: rupture or protrusion into right ventricle near or at tricuspid

annulus• Type IIIa: rupture or protrusion into right atrium

Guo HW, Sun XG, Xu JP, et al. A new and simple classification for the non-coronary sinus of Valsalva aneurysm. Eur J Cardiothorac Surg 2011;40:1047–51:from NCC

• 61.0% type I• 34.1% type IIa• 4.9% type Iiv

Association

• VSD:53.3%• RVOT obstruction :7.5% • aortic valvular malformations:5.2%

The SVAs from the NCC by Angiogram by Guo et al

• Type I: rupture or protrusion into right atrium not near the tricuspid annulus;• Type IIa: rupture or protrusion into right atrium near or at the

tricuspid annulus;• Type IIv: rupture or protrusion into right ventricle near or at the

tricuspid annulus

Imaging

• ECHO• Aortic root angiogram• CT aortogram

Management

• Gold: Surgery• Evolving: Transcathetor closure

Dr Lalita/Shashikanth/Shridhar/Barik

Please enjoy this memorable clip

http://youtu.be/ZdkFReqFwPI