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A sinus of Valsalva aneurysm is a rare cardiac anomaly characterized by an abnormal dilatation of the aortic root. This occurs due to a weakened elastic lamina at the junction of the aortic media and the annulus fibrosus. The aneurysm can be congenital or acquired and comprises up to 3.5% of all congenital cardiac defects. Due to the aneurysm’s physiologic function and location, it can present significant clinical consequences in both the rupture and unruptured state. We present the case of a middle-aged male with no significant medical history who was found to have a massive unruptured sinus of Valsalva aneurysm. He was treated surgically with no postoperative complications.
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A sinus of Valsalva aneurysm is a rare cardiac anomaly characterized by an abnormal dilatation of the aortic root. This occurs due to a weakened elastic lamina at the junction of the aortic media and the annulus fibrosus. The aneurysm can be congenital or acquired and comprises up to 3.5% of all congenital cardiac defects. Due to the aneurysm’s physiologic function and location, it can present significant clinical consequences in both the rupture and unruptured state. We present the case of a middle-aged male with no significant medical history who was found to have a massive unruptured sinus of Valsalva aneurysm. He was treated surgically with no postoperative complications.

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A 52-year-old male with no significant medical history presented to the emergency department with a two-week onset of dry cough, rhinorrhea, and worsening dyspnea on exertion. An electrocardiogram on admission revealed left ventricular hypertrophy with repolarization abnormalities. Due to concerns for new-onset heart failure, a complete two-dimensional transthoracic echocardiogram (TTE) was performed, which revealed a circular fine structure within the left atrium, suggestive of an aneurysm (<a ref-type="fig" href="#j_rjc-2024-0014_fig_001">Figure 1a</a>). To further investigate the findings on TTE, a transesophageal echocardiogram (TEE) was subsequently done, revealing a sinus of Valsalva aneurysm with an associated bicuspid aortic valve (<a ref-type="fig" href="#j_rjc-2024-0014_fig_001">Figure 1b</a>). The patient underwent surgical repair of the unruptured aneurysm using a patch cut from a Valsalva aortic prosthesis Gelweave ValsalvaTM graft (Terumo Vascutek). The postoperative course was uncomplicated, and the patient completely recovered after three months.
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<h2>Figure 1</h2>
<figCaption>(A) Apical four chamber view transthoracic echocardiography showing a circular fine structure within the left atrium (arrow). LV, left ventricle; RV, right ventricle; RA, right atrium. (B) Mid-esophageal short axis TEE showing bicuspid aortic valve (orange arrows) and the sinus of Valsalva aneurysm (blue arrow).</figCaption>
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Sinus of Valsalva aneurysm, or SOVA, is a cardiac defect that is congenital or acquired with an estimated incidence of approximately 0.09 % in the general population.<a ref-type="bibr" href="#j_rjc-2024-0014_ref_001">1</a> It is commonly associated with other congenital heart anomalies such as ventricular septal defects, bicuspid aortic valve, and pulmonary stenosis.<a ref-type="bibr" href="#j_rjc-2024-0014_ref_001">1</a>,<a ref-type="bibr" href="#j_rjc-2024-0014_ref_002">2</a> They originate from the right coronary sinus in 70 to 90 percent of cases, followed by the noncoronary sinus (10%-25%) and the left sinus (&lt;5%).<a ref-type="bibr" href="#j_rjc-2024-0014_ref_003">3</a> Clinical presentation may be asymptomatic or may include acute rupture that clinically manifests with chest pain, dyspnea, palpitations, and cardiac murmurs.<a ref-type="bibr" href="#j_rjc-2024-0014_ref_001">1</a>-<a ref-type="bibr" href="#j_rjc-2024-0014_ref_003">3</a> Cardiac computed tomography or magnetic resonance imaging may be used to aid in the diagnosis.<a ref-type="bibr" href="#j_rjc-2024-0014_ref_003">3</a> However, TEE is preferred for anatomical delineation of aneurysmal origination, which will appear on two-dimensional imaging as a thin-walled mobile structure that is circular in the short axis.<a ref-type="bibr" href="#j_rjc-2024-0014_ref_002">2</a>,<a ref-type="bibr" href="#j_rjc-2024-0014_ref_003">3</a> Surgical repair remains the preferred method of treatment.<a ref-type="bibr" href="#j_rjc-2024-0014_ref_003">3</a>,<a ref-type="bibr" href="#j_rjc-2024-0014_ref_004">4</a> In patients with a ruptured SOVA, transcatheter closure devices are an acceptable alternative in those with suitable anatomy and high risk for cardiac surgery.<a ref-type="bibr" href="#j_rjc-2024-0014_ref_002">2</a>,<a ref-type="bibr" href="#j_rjc-2024-0014_ref_005">5</a>
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Massive sinus of Valsalva aneurysm with an associated bicuspid aortic valve: A rare clinical image

Romanian Journal of Cardiology

This work is licensed under the Creative Commons Attribution 4.0 International License.

A sinus of Valsalva aneurysm is a rare cardiac anomaly characterized by an abnormal dilatation of the aortic root. This occurs due to a weakened elastic lamina...

Massive sinus of Valsalva aneurysm with an associated bicuspid aortic valve: A rare clinical image

Article Category: Image in Cardiology

Published Online: Jun 22, 2024

Page range: -

DOI: https://doi.org/10.2478/rjc-2024-0014

Keywords
Sinus of Valsalva aneurysm, Echocardiography, Bicuspid aortic valve, Cardiac magnetic resonance imaging, Cardiac computed tomography

© 2024 Kevan English, published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1

Massive sinus of Valsalva aneurysm with an associated bicuspid aortic valve: A rare clinical image

Article Category: Image in Cardiology

Published Online: Jun 22, 2024

Page range: -

DOI: https://doi.org/10.2478/rjc-2024-0014

KeywordsSinus of Valsalva aneurysm, Echocardiography, Bicuspid aortic valve, Cardiac magnetic resonance imaging, Cardiac computed tomography

© 2024 Kevan English, published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1

Keywords
Sinus of Valsalva aneurysm, Echocardiography, Bicuspid aortic valve, Cardiac magnetic resonance imaging, Cardiac computed tomography