Windsock pattern

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Windsock pattern or windsock lesion is one of the signs of left ventricular outflow tract aneurysm.

Diagnosis

Echocardiography

• Windsock pattern: Mitral Valve Left Atrium into Left Ventricular Outflow Tract 1

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• Windsock pattern: Mitral Valve Left Atrium into Left Ventricular Outflow Tract 2

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• Windsock pattern: Mitral Valve Left Atrium into Left Ventricular Outflow Tract 3

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• Windsock pattern: Mitral Valve Left Atrium into Left Ventricular Outflow Tract 4

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Pathomorphological Images

Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

• 

  Sinus of Valsalva Aneurysm: Gross; a beautiful picture of windsock opening of aneurysm beneath anterior leaflet of tricuspid valve into right ventricle

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  Sinus of Valsalva Aneurysm: Gross; an excellent picture; cut through aneurysm.

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  Sinus of Valsalva Aneurysm: Gross; An infected aneurysm with a ruptured aortic cusp due to endocarditis.

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  Sinus of Valsalva Aneurysm: Gross; difficult to orient but aneurysm is visible.

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  Sinus of Valsalva Aneurysm Infected: Gross; natural color, close-up view of coronary cusps with extensive ulceration and fibrinous material. Staphylococcus infection of a bicuspid valve.

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  Sinus of Valsalva Aneurysm Infected: Gross; natural color fibrin exudate and some valve scarring are easily seen but aneurysm not seen. The bicuspid valve requires careful look to appreciate Staphylococcus caused lesion.

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  Ruptured Sinus of Valsalva Aneurysm: Gross; natural color view from left atrium of left sinus aneurysm that is pointing into left atrium through mitral ring at anterior mitral commissure (the most unusual lesion).

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  Ruptured Sinus of Valsalva Aneurysm: Gross; natural color view of left ventricular outlet with hemorrhagic lesion in left coronary sinus.

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  Ruptured Sinus of Valsalva Aneurysm: Gross; natural color close-up of aneurysm in aortic valve.

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  Sinus of Valsalva Aneurysm: Gross fixed tissue shows aneurysm in noncoronary cusp about as well as possible see for picture with probe in aneurysm

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  Sinus of Valsalva Aneurysm: Gross fixed tissue close-up view with probe in non coronary sinus aneurysm see for photo without probe

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  Sinus of Valsalva Aneurysm Ruptured: Gross fixed tissue view of right side of heart showing site of rupture below tricuspid ring also patent foramen ovale

Additional Resources

• Brabram KR, Roberts WC. Fatal intrapericardial rupture of sinus of valsalva aneurysm. Am Heart J 1990; 120 (6 Pt 1): 1455-6.
• Edwards JE, Burchell HB. The pathological anatomy of the deficiencies between the aortic root and the heart including aortic sinus aneurysms. Thorax 1957; 12: 125-39.
• Tesler UF, Fiorilli R, Lisanti P. Repair of a ruptured sinus of valsalva aneurysm associated with annulo-aortic ectasia and coarctation of the aorta in a patient with Marfan s syndrome. Tex Heart Inst J 1997; 24 (2): 134-8.
• Koh KK, Lee KH, Kim SS, Lee SC, Jin SH, Cho SW. Ruptured aneurysm of the sinus of valsalva in a patient with Behcet s disease. Int J Cardiol 1994; 47 (2): 177-9.
• Hurley J, McGovern E. Rupture of a sinus of valsalva aneurysm due to aspergillus endocarditis. J Cardiovasc Surg (Torino) 1994; 35 (1): 75-7.
• Bansal RC, Wangsnes KM, Bailey L. Right aortic sinus of valsalva to right ventricle fistula complicating bacterial endocarditis of membranous ventricular septal defect. J Am Soc Echocardiogr 1993; 6 (3 Pt 1): 308-11.
• Murral EG, Minami K, Kortke H, Seggewiss H, Korfer R. Traumatic sinus of valsalva fistula and aortic valve rupture. Ann Thorac Surg 1993; 55 (3): 760-1.
• Cooperberg P, Mercier EN, Mulder D, Winsberg GF. Rupture of a sinus of valsalva aneurysm. Report of a case diagnosed pre-operatively by echocardiography. Radiology 1974; 113: 171-2.
• Wang KY, St John Sutton M, Ho HY, Ting CT. Congenital sinus of valsalva aneurysm: a multiplane transoesophageal experience. J Am Soc Echocardiogr 1997; 10 (9): 956-63.
• Kulan K, Kulan C, Tuncer C, Komsuoglu, B, Zengin M. Echocardiography and magnetic resonance imaging of sinus of valsalva aneurysm with rupture into the ventricle. J Cardiovasc Surg (Torino) 1996; 37 (6): 639-41.
• Sakakibara S, Konno S. Congenital aneurysm of the sinus of valsalva: anatomy and classification. Am Heart J 1962; 63: 405-24.
• Dev V, Goswami KC, Shrivastava S, Bahl VK, Saxena A. Echocardiographic diagnosis of aneurysm of the sinus of valsalva. Am Heart J 1993; 126 (4): 930-36.
• Isomura T, Hisatomi K, Hirano A, Satho T, Kosuga K, Ohishi K. Ruptured aneurysms of the sinus of valsalva. J Cardiovasc Surg (Torino) 1994; 35 (2): 135-8.
• Lukacs L, Bartek I, Haan A, Hankoczy J, Arvay A. Ruptured aneurysms of the sinus of valsalva. Eur J Cardiothorac Surg 1992; 6 (1): 15-7.
• Van Son JA, Danielson GK, Schaff HV, Orszulak TA, Edwards WD, Seward JB. Long term outcome of surgical repair of ruptured sinus of valsalva. Circulation 1994; 90 (5 Pt 2): II20-9.
• Jeyamalar R, Kannan P. Ruptured aneurysms of the sinus of valsalva. Med J Malaya 1991; 46 (4): 371-5.

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