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Latest revision as of 15:12, 18 August 2021

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].

OR

[Disease name] may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4].

OR

[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].

OR

Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.

OR

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].

OR

The staging of [malignancy name] is based on the [staging system].

OR

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

[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].

OR

[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].

OR

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].

OR

Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

OR

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].

OR

According to the [guideline name], screening for [disease name] is not recommended.

OR

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

The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

There are no established criteria for the diagnosis of [disease name].

History and Symptoms

The majority of patients with [disease name] are asymptomatic.

OR

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].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

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].

OR

Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

OR

[Test] is usually normal among patients with [disease name].

OR

Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].

OR

There are no diagnostic laboratory findings associated with [disease name].

Electrocardiogram

There are no ECG findings associated with [disease name].

OR

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

There are no x-ray findings associated with [disease name].

OR

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].

OR

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].

OR

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].

OR

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].

OR

[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].

OR

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].

OR

[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].

OR

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].

OR

[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].

OR

[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].

OR

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].

OR

There are no available vaccines against [disease name].

OR

Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

OR

[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].

OR

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.

Template:WikiDoc Sources

[BrickerAvutu2010-1] 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.

[HiremathDiwakar2019-2] 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.

[ChenLiang2019-3] 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.

[StróżykKołaczkowska2018-4] 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.

[WingoAngelis2019-5] 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.

[OhnoWatanabe2019-6] 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.

[UrbanskiHirao2019-7] 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.

[SeoPark2019-8] 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.

[9] David Bass & Vijai S.. Tivakaran (2020). "Sinus Of Valsalva Aneurysm". PMID 28846266. Unknown parameter |month= ignored (help)

[ChanCharalambous2018-10] 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.

[YanHuo2008-11] 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.

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@@ Line 55: / Line 55: @@
 * 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]].<ref name="HiremathDiwakar2019">{{cite journal|last1=Hiremath|first1=ChannabasavarajS|last2=Diwakar|first2=Anitha|last3=Patnaik|first3=SathyaSwaroop|last4=Chalam|first4=KolliS|last5=Dash|first5=Parvatkumar|title=Rupture of sinus of valsalva – A 15 years single institutional retrospective review: Preoperative heart failure has an impact on post operative outcome?|journal=Annals of Cardiac Anaesthesia|volume=22|issue=1|year=2019|pages=24|issn=0971-9784|doi=10.4103/aca.ACA_243_17}}</ref>. It also can cause mild aortic regurgitation in one third of patients.
-* ruptured sinus of valsalva aneurysm is a feared complication:<ref name="ChenLiang2019">{{cite journal|last1=Chen|first1=Jing|last2=Liang|first2=Hai-Nan|last3=Wu|first3=Lin|last4=Dong|first4=Shao-Hong|last5=Li|first5=Jiang-Hua|title=Right sinus of Valsalva aneurysm spontaneously dissecting into the interventricular septum in a rare case of Behcet’s disease|journal=European Heart Journal - Cardiovascular Imaging|volume=20|issue=5|year=2019|pages=601–601|issn=2047-2404|doi=10.1093/ehjci/jey218}}</ref>
+* ruptured sinus of valsalva aneurysm is a feared complication:<ref name="ChenLiang2019">{{cite journal|last1=Chen|first1=Jing|last2=Liang|first2=Hai-Nan|last3=Wu|first3=Lin|last4=Dong|first4=Shao-Hong|last5=Li|first5=Jiang-Hua|title=Right sinus of Valsalva aneurysm spontaneously dissecting into the interventricular septum in a rare case of Behcet’s disease|journal=European Heart Journal - Cardiovascular Imaging|volume=20|issue=5|year=2019|pages=601–601|issn=2047-2404|doi=10.1093/ehjci/jey218}}</ref><ref name="StróżykKołaczkowska2018">{{cite journal|last1=Stróżyk|first1=Aneta|last2=Kołaczkowska|first2=Magdalena|last3=Fijałkowska|first3=Jadwiga|last4=Siondalski|first4=Piotr|last5=Fijałkowski|first5=Marcin|title=Sinus of Valsalva rupture in a patient with a mechanical aortic prosthesis: aneurysm dissecting into the interventricular septum|journal=Kardiologia Polska|year=2018|pages=1742–1742|issn=0022-9032|doi=10.5603/KP.2018.0235}}</ref>
 ** 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:<ref name="WingoAngelis2019">{{cite journal|last1=Wingo|first1=Matthew|last2=Angelis|first2=Paolo|last3=Worku|first3=Berhane M.|last4=Leonard|first4=Jeremy R.|last5=Khan|first5=Faiza M.|last6=Hameed|first6=Irbaz|last7=Lau|first7=Christopher|last8=Gaudino|first8=Mario|last9=Girardi|first9=Leonard N.|title=Sinus of Valsalva aneurysm repairs: Operative technique and lessons learned|journal=Journal of Cardiac Surgery|volume=34|issue=6|year=2019|pages=400–403|issn=0886-0440|doi=10.1111/jocs.14041}}</ref>
-Disease name] may be caused by [cause1], [cause2], or [cause3].
+* Sinus of valsalva aneurysm can be both congenital and acquired:<ref name="WingoAngelis2019">{{cite journal|last1=Wingo|first1=Matthew|last2=Angelis|first2=Paolo|last3=Worku|first3=Berhane M.|last4=Leonard|first4=Jeremy R.|last5=Khan|first5=Faiza M.|last6=Hameed|first6=Irbaz|last7=Lau|first7=Christopher|last8=Gaudino|first8=Mario|last9=Girardi|first9=Leonard N.|title=Sinus of Valsalva aneurysm repairs: Operative technique and lessons learned|journal=Journal of Cardiac Surgery|volume=34|issue=6|year=2019|pages=400–403|issn=0886-0440|doi=10.1111/jocs.14041}}</ref>
+** Emberiologically sinus of valsalva aneurysm forms first as a blind diverticulum. the congenital form has been linked to connective tissue diseases:<ref name="OhnoWatanabe2019">{{cite journal|last1=Ohno|first1=Nobuhisa|last2=Watanabe|first2=Kentaro|last3=Maeda|first3=Toshi|last4=Kato|first4=Otohime|last5=Ueno|first5=Go|last6=Yoshizawa|first6=Kosuke|last7=Fujiwara|first7=Keiichi|title=A rare case of unruptured extracardiac multiple sinus of Valsalva aneurysms originating from the orifices with partial aortic wall defects|journal=Surgical Case Reports|volume=5|issue=1|year=2019|issn=2198-7793|doi=10.1186/s40792-019-0608-7}}</ref> <ref name="UrbanskiHirao2019">{{cite journal|last1=Urbanski|first1=Paul P.|last2=Hirao|first2=Shingo|last3=Irimie|first3=Vadim|title=Root repair in patient with huge sinus Valsalva aneurysm and severe aortic regurgitation|journal=General Thoracic and Cardiovascular Surgery|volume=68|issue=5|year=2019|pages=530–533|issn=1863-6705|doi=10.1007/s11748-019-01104-8}}</ref>
+***[[Marfan's syndrome]]
+***[[Ehlers-Danlos syndrome]]
+***[[Bicuspid aortic valves]]
+** Acquired forms of sinus of valsalva aneurysm is also seen with connective tissue diseases:
+*** Infections that weaken elastic tissue:
+****[[Syphilis]]
+****[[Bacterial endocarditis]]
+****[[Tuberculosis]]
+***[[Atherosclerosis]] and medial cystic necrosis
+*** Chest trauma
+***[[Iatrogenic]] injury during aortic valve surgery
+***[[vasculitis]] ([[Takayasu's arteritis]])
-OR
+<br />
-Common causes of [disease] include [cause1], [cause2], and [cause3].
-OR
-The most common cause of [disease name] is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].
-OR
-The cause of [disease name] has not been identified. To review risk factors for the development of [disease name], click [[Pericarditis causes#Overview|here]].
 ==Differentiating ((Page name)) from other Diseases==
@@ Line 84: / Line 86: @@
 ==Epidemiology and Demographics==
-The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.
-OR
-In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide.
-OR
-In [year], the incidence of [disease name] is approximately [number range] per 100,000 individuals with a case-fatality rate of [number range]%.
-Patients of all age groups may develop [disease name].
-OR
-The incidence of [disease name] increases with age; the median age at diagnosis is [#] years.
-OR
-[Disease name] commonly affects individuals younger than/older than [number of years] years of age.
-OR
-[Chronic disease name] is usually first diagnosed among [age group].
-OR
-[Acute disease name] commonly affects [age group].
-There is no racial predilection to [disease name].
-OR
-[Disease name] usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop [disease name].
-[Disease name] affects men and women equally.
-OR
-[Gender 1] are more commonly affected by [disease name] than [gender 2]. The [gender 1] to [gender 2] ratio is approximately [number > 1] to 1.
-The majority of [disease name] cases are reported in [geographical region].
-OR
-[Disease name] is a common/rare disease that tends to affect [patient population 1] and [patient population 2].
+* Sinus of valsalva aneurysm  is found in approximately 9 people out of 10000 in general populatin.<ref name="SeoPark2019">{{cite journal|last1=Seo|first1=Kyoung-Woo|last2=Park|first2=Jin-Sun|title=Sinus of Valsalva Aneurysm and Multiple Aortic Aneurysms Provoked by Viral Myocarditis|journal=Korean Circulation Journal|volume=49|issue=2|year=2019|pages=194|issn=1738-5520|doi=10.4070/kcj.2018.0309}}</ref>
+* Sinus of valsalva comprise 3.5% of all congenital heart defects.
+* sinus of valsalva affects males four times more likely than females.<ref>{{Cite journal|author = [[David Bass]] & [[Vijai S.. Tivakaran]]| title = Sinus Of Valsalva Aneurysm|year = 2020|month = January|pmid = 28846266}}</ref>
+* higher rates are reported among Asian groups.
 ==Risk Factors==
@@ Line 165: / Line 119: @@
 ==Natural History, Complications, and Prognosis==
-If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
-OR
-Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
-OR
-Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
+* Sinus of valsalva can be completely asymptomatic.
+* It can present with non-spesific complaints such as:
+** [[Dyspnea]]
+** [[Chest pain]]
+** [[Palpitation]]
+** [[Unconsciousness|Loss of consciousness]]
+* Classic physical findings are not present until rupture of n sinus of valsalva.
+* When not ruptured, They may present with a diastolic descrescendo [[Heart murmur|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==
@@ Line 303: / Line 257: @@
 ==Treatment==
 ===Medical Therapy===
-There is no treatment for [disease name]; the mainstay of therapy is supportive care.
+There is no medical treatment for rupture of sinus of valsalva; the mainstay of therapy is surgical management.<ref name="ChanCharalambous2018">{{cite journal|last1=Chan|first1=Nicholas|last2=Charalambous|first2=Marinos|last3=Fuschetto|first3=David P.|last4=Fuschetto|first4=Orlando|last5=Makaryus|first5=John N.|title=Severe compression of the left circumflex coronary artery by a large sinus of Valsalva aneurysm|journal=Journal of Cardiovascular Computed Tomography|year=2018|issn=19345925|doi=10.1016/j.jcct.2018.11.001}}</ref>
-OR
-Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
-OR
-The majority of cases of [disease name] are self-limited and require only supportive care.
-OR
-[Disease name] is a medical emergency and requires prompt treatment.
-OR
-The mainstay of treatment for [disease name] is [therapy].
-OR
-The optimal therapy for [malignancy name] depends on the stage at diagnosis.
-OR
-[Therapy] is recommended among all patients who develop [disease name].
-OR
-Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
-OR
-Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
-OR
-Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
-OR
-Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
 ===Surgery===
-Surgical intervention is not recommended for the management of [disease name].
+Surgery is not the first-line treatment option for patients with ruptured sinus of valsalva.<ref name="YanHuo2008">{{cite journal|last1=Yan|first1=Fei|last2=Huo|first2=Qiang|last3=Qiao|first3=Jun|last4=Murat|first4=Vakeli|last5=Ma|first5=Song-Feng|title=Surgery for Sinus of Valsalva Aneurysm: 27-Year Experience with 100 Patients|journal=Asian Cardiovascular and Thoracic Annals|volume=16|issue=5|year=2008|pages=361–365|issn=0218-4923|doi=10.1177/021849230801600504}}</ref>
-OR
-Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]
-OR
-The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].
-OR
-The feasibility of surgery depends on the stage of [malignancy] at diagnosis.
-OR
-Surgery is the mainstay of treatment for [disease or malignancy].
+* Non ruptured sinus of valsalva aneurysm should be surgically repaired if :
+** It is assosiated with significant symptome
+** It is rapidly enlarging
 ===Primary Prevention===
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