Sinus of Valsalva Aneurysm Pre-post Tricuspid L-R shunt
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