Echocardiographic features of an aneurysm of the left sinus of Valsalva

Diagnosis and treatment options for sinus of Valsalva aneurysms: A narrative review

Sinus of Valsalva aneurysm (SoVA) is a rare cardiac defect that may be congenital or acquired. It is characterized by abnormal dilatation of the aortic root due to a weakened elastic lamina at the junction of the annulus fibrosus and the aortic media. SoVAs are present in approximately 0.09% of the general population and comprise up to 3.5% of all congenital cardiac defects. It is usually found incidentally on cardiac imaging, with a higher incidence observed in the Western populations and a male-to-female ratio of 4:1. A transthoracic two-dimensional echocardiogram is the initial diagnostic test of choice, which may reveal the characteristic “windsock deformity” that clinches the diagnosis. Other imaging modalities, such as transesophageal echocardiography and cardiac computed tomography angiography, help provide more extensive details of the aneurysm and its adjacent structures. Management options for ruptured and unruptured SoVA include surgical repair or transcatheter closure, which serves as a game-changing development in treatment. This article aims to provide background information on the epidemiology, pathophysiology, diagnosis, and recent advancements over the past decade in the management of SoVAs.

The evaluation of the abdominal aorta: a "how-to" for cardiac sonographers

A thorough evaluation of the abdominal aorta can be readily achieved by use of the standard views of the echocardiographic examination. The ultrasound evaluation of the abdominal aorta represents a logical extension of the standard echocardiographic examination of the adult patient. This article provides the information needed to carry out a complete ultrasound examination of the abdominal aorta including the anatomy, the vascular disease, and the steps involved in accomplishing the ultrasound examination of the abdominal aorta.

An unusual echocardiographic finding in a ruptured sinus of Valsalva aneurysm

A patient with a ruptured sinus of Valsalva aneurysm (RSVA) demonstrated an unusual two-dimensional echocardiographic manifestation of this entity. A discrete mass of echoes, appearing attached to a posterior leaflet of the tricuspid valve, moved to and fro into the right ventricle during diastole and into the right atrium in systole. This echocardiographic appearance mimics a vegetation of the tricuspid valve, a flail tricuspid leaflet, a right atrial myxoma or a pedunculated right atrial thrombus. Therefore, the differential diagnosis of this echocardiographic finding should include RSVA in addition to the above mentioned disorders.

Aneurysms of sinus of Valsalva: two-dimensional echocardiographic diagnosis and recognition of rupture into the right heart cavities

The aim of this study was to evaluate the role of echocardiography in the diagnosis of sinus of Valsalva aneurysms projecting toward the right heart cavities. Three patients who had a ruptured aneurysm of a sinus of Valsalva diagnosed by echocardiography and confirmed by catheterization underwent cardiac surgery. In two patients, the aneurysm originated from the right coronary sinus and had perforated into either the inflow or outflow tract of the right ventricle. In the third patient, the aneurysm, which originated from the noncoronary sinus, ruptured into the atrium. A fourth patient was also investigated and had an unruptured aneurysm of the right coronary sinus projecting into the right ventricular outflow tract. M-mode, two-dimensional and contrast echocardiographic studies were performed before cardiac catheterization in all patients and after surgery in three patients. M-mode echocardiography was useful only when the aneurysm had an anterior projection, whether or not the aneurysm was ruptured. Conversely, two-dimensional echocardiography was always able to identify the aneurysmal sac which appeared as an abnormal circular thin-walled structure protruding into the right heart cavities. By using multiple views, it was possible to investigate the whole abnormal structure and locate the sinus from which the aneurysm originated. The use of the echo contrast technique allowed more precise definition of the aneurysmal sac and diagnosis of a left to right shunt by demonstrating a negative contrast image in the right cavities. On the other hand, no negative contrast image was recorded in the patient with an unruptured aneurysm or in the two instances of a successful surgically reconstructed aorta.

Echocardiographic features of a mycotic aneurysm of the left ventricular outflow tract caused by perforation of mitral-aortic intervalvular fibrosa

We present the apparently unique M-mode and two-dimensional echocardiographic features of a surgically confirmed pseudoaneurysm of the left ventricular outflow tract, which probably developed as a result of perforation of the mitral-aortic intervalvular fibrosa. Echocardiographic studies revealed an aneurysmal sac situated between the aortic root and the left atrium. The aneurysm expanded in systole and collapsed or emptied in diastole, suggesting direct communication with the left ventricle. Such an aneurysm must be differentiated from various pathologic findings of the aortic root. The location and characteristic motion during the cardiac cycle should alert the clinician to the correct diagnosis of such an aneurysm.

Echocardiographic detection of mitral valve aneurysm in patient with infective endocarditis

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Echocardiographic diagnosis of congenital sinus of Valsalva aneurysm with dissection of the interventricular septum

A case is reported in which a congenital aneurysm of the right coronary sinus of Valsalva ruptured and dissected into the interventricular septum. M-mode and cross-sectional echocardiographic examination allowed accurate preoperative assessment of the pathologic anatomy, which was confirmed by angiography, surgery and autopsy. Dissection of the interventricular septum by a congenital sinus of Valsalva aneurysm is a rare lesion, has a poor prognosis, and can be diagnosed noninvasively with echocardiography.

Echocardiographic features of an unruptured aneurysm of the right sinus of Valsalva

A 2-cm aneurysm of the right sinus of Valsalva was documented in a patient with a prosthetic aortic valve. The M-mode findings differed from prior reports and mimicked those of aortic root dissection or a catheter placed in the right ventricular outflow tract. Two-dimensional echocardiograms readily distinguished the aneurysm of the right sinus of Valsalva from the alternative possibilities.

Aneurysm of the left sinus of Valsalva draining into the right atrium

We report the case of an arteriovenous fistula connecting the aorta to the right atrium, due to a ruptured aneurysm of the left sinus of Valsalva. Clinical, echocardiographic, and angiographic aspects of this unusual lesion are discussed and correlated. Emphasis is put on the diagnostic value of the echocardiogram; a characteristic dense echo parallel to the posterior aortic wall is seen, along with signs of right ventricular volume overload. Combined with the case history and auscultatory finding (a continuous murmur on the right sternal edge), this may lead to the correct diagnosis by noninvasive means.

Right sinus of Valsalva-right atrial fistula secondary to nonpenetrating chest trauma: a case report with description of noninvasive diagnostic features

A sinus of Valsalva-right atrial fistula secondary to nonpenetrating chest trauma is described. Echocardiogrpahy demonstrated diastolic fluttering of the anterior tricuspid valve, suggesting a left-to-right shunt at the level of the right atrium. External jugular venous pulse tracings revealed large alpha waves and attenuation of the y descent. Cardiac catheterization disclosed a fistulous communication between the right sinus of Valsalva and right atrium. After surgical repair of the fistula, the ultrasonic recording and external pulse tracing reverted to normal. We believe this is the first description of such a shunt after blunt thoracic trauma.