Rupture of the Sinus of Valsalva
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ramyar Ghandriz MD[2]
Synonyms and keywords: SOVA rupture
Overview
Historical Perspective
[Disease name] was first discovered by [name of scientist], a [nationality + occupation], in [year]/during/following [event].
The association between [important risk factor/cause] and [disease name] was made in/during [year/event].
In [year], [scientist] was the first to discover the association between [risk factor] and the development of [disease name].
In [year], [gene] mutations were first implicated in the pathogenesis of [disease name].
There have been several outbreaks of [disease name], including -----.
In [year], [diagnostic test/therapy] was developed by [scientist] to treat/diagnose [disease name].
Classification
There is no established system for the classification of [disease name].
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[Disease name] may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4].
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[Disease name] may be classified into [large number > 6] subtypes based on [classification method 1], [classification method 2], and [classification method 3]. [Disease name] may be classified into several subtypes based on [classification method 1], [classification method 2], and [classification method 3].
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Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.
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If the staging system involves specific and characteristic findings and features: According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].
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The staging of [malignancy name] is based on the [staging system].
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There is no established system for the staging of [malignancy name].
Pathophysiology
- Sinus of valsalva is an enlargement of the aortic root, between the aortic valve and sinotubular ridge. [1]
- Anatomic positioning of each sinus is a major determinant of clinical outcome.
- Non-ruptured SOVA is usually asymptomatic, however it can lead to cardiac arrhythmia such as atrial fibrillation and complete heart block.[2]. It also can cause mild aortic regurgitation in one third of patients.
- ruptured sinus of valsalva aneurysm is a feared complication:[3][4]
- Rupture of the right and non-coronary sinus typically results in communication between the aorta and either right atrium or ventricle, a left to right shunt.
- left sinus of valsalva rupture is clinically less significant., causing communication to the left atrium or ventricle.
Causes
- Sinus of valsalva aneurysm can be both congenital and acquired:[5]
- Emberiologically sinus of valsalva aneurysm forms first as a blind diverticulum. the congenital form has been linked to connective tissue diseases:[6] [7]
- Acquired forms of sinus of valsalva aneurysm is also seen with connective tissue diseases:
- Infections that weaken elastic tissue:
- Atherosclerosis and medial cystic necrosis
- Chest trauma
- Iatrogenic injury during aortic valve surgery
- vasculitis (Takayasu's arteritis)
Differentiating ((Page name)) from other Diseases
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[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
Epidemiology and Demographics
- Sinus of valsalva aneurysm is found in approximately 9 people out of 10000 in general populatin.[8]
- Sinus of valsalva comprise 3.5% of all congenital heart defects.
- sinus of valsalva affects males four times more likely than females.[9]
- higher rates are reported among Asian groups.
Risk Factors
There are no established risk factors for [disease name].
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The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].
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Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
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Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.
Screening
There is insufficient evidence to recommend routine screening for [disease/malignancy].
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According to the [guideline name], screening for [disease name] is not recommended.
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According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].
Natural History, Complications, and Prognosis
- Sinus of valsalva can be completely asymptomatic.
- It can present with non-spesific complaints such as:
- Classic physical findings are not present until rupture of n sinus of valsalva.
- When not ruptured, They may present with a diastolic descrescendo murmur suggestive of aortic regurgitation., while in ruptured cases there will be a continuous murmur and decreased exercise tolerence and in advanced phase, even congestive heart failure.
Diagnosis
Diagnostic Study of Choice
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There are no established criteria for the diagnosis of [disease name].
History and Symptoms
The majority of patients with [disease name] are asymptomatic.
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The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
Physical Examination
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
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Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
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The presence of [finding(s)] on physical examination is diagnostic of [disease name].
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The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
Laboratory Findings
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
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Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
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[Test] is usually normal among patients with [disease name].
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Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
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There are no diagnostic laboratory findings associated with [disease name].
Electrocardiogram
There are no ECG findings associated with [disease name].
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An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
X-ray
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An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
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There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
Echocardiography or Ultrasound
There are no echocardiography/ultrasound findings associated with [disease name].
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Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
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There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
CT scan
There are no CT scan findings associated with [disease name].
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[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
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There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
MRI
There are no MRI findings associated with [disease name].
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[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
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There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
Other Imaging Findings
There are no other imaging findings associated with [disease name].
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[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
Other Diagnostic Studies
There are no other diagnostic studies associated with [disease name].
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[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
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Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].
Treatment
Medical Therapy
There is no medical treatment for rupture of sinus of valsalva; the mainstay of therapy is surgical management.[10]
Surgery
Surgery is not the first-line treatment option for patients with ruptured sinus of valsalva.[11]
- Non ruptured sinus of valsalva aneurysm should be surgically repaired if :
- It is assosiated with significant symptome
- It is rapidly enlarging
Primary Prevention
There are no established measures for the primary prevention of [disease name].
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There are no available vaccines against [disease name].
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Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
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[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].
Secondary Prevention
There are no established measures for the secondary prevention of [disease name].
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Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].
References
- ↑ Bricker, Aliye Ozsoyoglu; Avutu, Bindu; Mohammed, Tan-Lucien H.; Williamson, Eric E.; Syed, Imran S.; Julsrud, Paul R.; Schoenhagen, Paul; Kirsch, Jacobo (2010). "Valsalva Sinus Aneurysms: Findings at CT and MR Imaging". RadioGraphics. 30 (1): 99–110. doi:10.1148/rg.301095719. ISSN 0271-5333.
- ↑ Hiremath, ChannabasavarajS; Diwakar, Anitha; Patnaik, SathyaSwaroop; Chalam, KolliS; Dash, Parvatkumar (2019). "Rupture of sinus of valsalva – A 15 years single institutional retrospective review: Preoperative heart failure has an impact on post operative outcome?". Annals of Cardiac Anaesthesia. 22 (1): 24. doi:10.4103/aca.ACA_243_17. ISSN 0971-9784.
- ↑ Chen, Jing; Liang, Hai-Nan; Wu, Lin; Dong, Shao-Hong; Li, Jiang-Hua (2019). "Right sinus of Valsalva aneurysm spontaneously dissecting into the interventricular septum in a rare case of Behcet's disease". European Heart Journal - Cardiovascular Imaging. 20 (5): 601–601. doi:10.1093/ehjci/jey218. ISSN 2047-2404.
- ↑ Stróżyk, Aneta; Kołaczkowska, Magdalena; Fijałkowska, Jadwiga; Siondalski, Piotr; Fijałkowski, Marcin (2018). "Sinus of Valsalva rupture in a patient with a mechanical aortic prosthesis: aneurysm dissecting into the interventricular septum". Kardiologia Polska: 1742–1742. doi:10.5603/KP.2018.0235. ISSN 0022-9032.
- ↑ Wingo, Matthew; Angelis, Paolo; Worku, Berhane M.; Leonard, Jeremy R.; Khan, Faiza M.; Hameed, Irbaz; Lau, Christopher; Gaudino, Mario; Girardi, Leonard N. (2019). "Sinus of Valsalva aneurysm repairs: Operative technique and lessons learned". Journal of Cardiac Surgery. 34 (6): 400–403. doi:10.1111/jocs.14041. ISSN 0886-0440.
- ↑ Ohno, Nobuhisa; Watanabe, Kentaro; Maeda, Toshi; Kato, Otohime; Ueno, Go; Yoshizawa, Kosuke; Fujiwara, Keiichi (2019). "A rare case of unruptured extracardiac multiple sinus of Valsalva aneurysms originating from the orifices with partial aortic wall defects". Surgical Case Reports. 5 (1). doi:10.1186/s40792-019-0608-7. ISSN 2198-7793.
- ↑ Urbanski, Paul P.; Hirao, Shingo; Irimie, Vadim (2019). "Root repair in patient with huge sinus Valsalva aneurysm and severe aortic regurgitation". General Thoracic and Cardiovascular Surgery. 68 (5): 530–533. doi:10.1007/s11748-019-01104-8. ISSN 1863-6705.
- ↑ Seo, Kyoung-Woo; Park, Jin-Sun (2019). "Sinus of Valsalva Aneurysm and Multiple Aortic Aneurysms Provoked by Viral Myocarditis". Korean Circulation Journal. 49 (2): 194. doi:10.4070/kcj.2018.0309. ISSN 1738-5520.
- ↑ David Bass & Vijai S.. Tivakaran (2020). "Sinus Of Valsalva Aneurysm". PMID 28846266. Unknown parameter
|month=ignored (help) - ↑ Chan, Nicholas; Charalambous, Marinos; Fuschetto, David P.; Fuschetto, Orlando; Makaryus, John N. (2018). "Severe compression of the left circumflex coronary artery by a large sinus of Valsalva aneurysm". Journal of Cardiovascular Computed Tomography. doi:10.1016/j.jcct.2018.11.001. ISSN 1934-5925.
- ↑ Yan, Fei; Huo, Qiang; Qiao, Jun; Murat, Vakeli; Ma, Song-Feng (2008). "Surgery for Sinus of Valsalva Aneurysm: 27-Year Experience with 100 Patients". Asian Cardiovascular and Thoracic Annals. 16 (5): 361–365. doi:10.1177/021849230801600504. ISSN 0218-4923.