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| | {{CMG}}; '''Associate Editor(s)-In-Chief:'''[[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]][mailto:psingh@perfuse.org]; '''Assistant Editor(s)-In-Chief:''' [[Kristin Feeney|Kristin Feeney, B.S.]][mailto:kfeeney@perfuse.org] |
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| '''Associate Editors-In-Chief:'''[[Priyamvada Singh]], [[MBBS]]
| | ==[[Aneurysm of sinus of valsalva overview|Overview]]== |
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| {{Editor Help}}
| | ==[[Aneurysm of sinus of valsalva pathophysiology|Pathophysiology]]== |
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| ==Overview== | | ==[[Aneurysm of sinus of valsalva epidemiology and demographics|Epidemiology and demographics]]== |
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| ''''[[Aneurysm]] of the [[aortic sinus]]'''', also known as the [[sinus of Valsalva]], is comparatively rare, occurring in about one person in every thousand.
| | ==[[Aneurysm of sinus of valsalva natural history|Natural history, Complications, and Prognosis]]== |
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| When present, it is usually in either the right (65-85%) or in the noncoronary (10-30%) sinus, rarely in the left (< 5%) sinus. This type of aneurysm is typically [[birth defects|congenital]] and may be associated with [[heart defects]].
| | ==[[Aneurysm of sinus of valsalva causes|Causes]]== |
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| It is sometimes associated with [[Marfan syndrome]] or [[Loeys-Dietz syndrome]], but may also result from [[Ehlers-Danlos syndrome]], [[atherosclerosis]], [[syphilis]], [[cystic medial necrosis]], chest injury, or [[infective endocarditis]].
| | ==[[Aneurysm of sinus of valsalva differential diagnosis|Differentiating Aneurysm of sinus of valsalva from other Disorders]]== |
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| If unruptured, this type aneurysm may be asymptomatic and therefore go undetected until symptoms appear or [[medical imaging]] is performed for other reasons.
| | ==Diagnosis== |
| | [[Aneurysm of sinus of valsalva history and symptoms|History and Symptoms]] | [[Aneurysm of sinus of valsalva physical examination|Physical Examination]] | [[Aneurysm of sinus of valsalva laboratory tests|Laboratory Tests]] | [[Aneurysm of sinus of valsalva electrocardiogram | Electrocardiogram]] | [[Aneurysm of sinus of valsalva chest x ray|Chest X Ray]] | [[Aneurysm of sinus of valsalva MRI|MRI]] | [[Aneurysm of sinus of valsalva CT|CT]] | [[Aneurysm of sinus of valsalva echocardiography|Echocardiography]] | [[Aneurysm of sinus of valsalva other imaging findings|Other Imaging Findings]] | [[Aneurysm of sinus of valsalva other diagnostic studies|Other Diagnostic Studies]] |
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| ==Treatment== | | ==Treatment== |
| | '''Medical:''' [[Aneurysm of sinus of valsalva medical therapy|Medical Therapy]] |
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| Medical therapy of [[aneurysm]] of the [[aortic sinus]] includes [[blood pressure]] control through the use of drugs, such as [[beta blockers]]. The definitive treatment is surgical repair.
| | '''Surgical:''' [[Aneurysm of sinus of valsalva surgery|Surgery]] |
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| The determination to perform surgery is usually based upon the diameter of the aortic root and the rate of increase in its size, as determined through repeated [[echocardiography]].
| | [[Aneurysm of sinus of valsalva primary prevention|Primary Prevention]] | [[Aneurysm of sinus of valsalva secondary prevention|Secondary Prevention]] | [[Aneurysm of sinus of valsalva cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Aneurysm of sinus of valsalva future or investigational therapies|Future or Investigational Therapies]] |
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| ===Echocardiography=== | | ==References== |
| | {{reflist|2}} |
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| * Windsock pattern: Mitral Valve Left Atrium into Left Ventricular Outflow Tract 1
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| <googlevideo>-3821607315131755147&hl=en</googlevideo>
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| * Windsock pattern: Mitral Valve Left Atrium into Left Ventricular Outflow Tract 2
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| <googlevideo>-3320027863699784928&hl=en</googlevideo>
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| * Windsock pattern: Mitral Valve Left Atrium into Left Ventricular Outflow Tract 3
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| <googlevideo>4720705474340891458&hl=en</googlevideo>
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| * Windsock pattern: Mitral Valve Left Atrium into Left Ventricular Outflow Tract 4
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| <googlevideo>2013579120698898377&hl=en</googlevideo>
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| ==Pathomorphological Images==
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| <small> [http://www.peir.net Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology] </small>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Sinus valsalva aneurysm 1.jpg|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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| Image:Sinus valsalva aneurysm 2.jpg|Sinus of Valsalva Aneurysm: Gross; an excellent picture; cut through [[aneurysm]].
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| Image:Sinus valsalva aneurysm 3.jpg|Sinus of Valsalva Aneurysm: Gross; An infected [[aneurysm]] with a ruptured aortic cusp due to [[endocarditis]].
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Sinus valsalva aneurysm 4.jpg|Sinus of Valsalva Aneurysm: Gross; difficult to orient but [[aneurysm]] is visible.
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| Image:Sinus valsalva aneurysm 5.jpeg|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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| Image:Sinus valsalva aneurysm 6.jpeg|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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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Sinus valsalva aneurysm 7.jpeg|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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| Image:Sinus valsalva aneurysm 8.jpeg|Ruptured Sinus of Valsalva Aneurysm: Gross; natural color view of left ventricular outlet with hemorrhagic lesion in left coronary sinus.
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| Image:Sinus valsalva aneurysm 9.jpeg|Ruptured Sinus of Valsalva Aneurysm: Gross; natural color close-up of aneurysm in aortic valve.
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Sinus valsalva aneurysm 10.jpg|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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| Image:Sinus valsalva aneurysm 11.jpg|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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| Image:Sinus valsalva aneurysm 12.jpg|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]]
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| </gallery>
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| </div>
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| ==Complications==
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| ===Ruptured Sinus of Valsalva Aneurysm===
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| ====Ruptured Sinus of Valsalva Aneurysm 1====
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| <googlevideo>-1407465513311541728&hl=en</googlevideo>
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| ====Ruptured Sinus of Valsalva Aneurysm 2====
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| <googlevideo>-1994600377765970692&hl=en</googlevideo>
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| ====Ruptured Sinus of Valsalva Aneurysm 3====
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| <googlevideo>824179299384545783&hl=en</googlevideo>
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| ====Ruptured Sinus of Valsalva Aneurysm 4====
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| <googlevideo>7638821322249946078&hl=en</googlevideo>
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| ====Ruptured Sinus of Valsalva Aneurysm 5====
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| <googlevideo>-3096832469384944636&hl=en</googlevideo>
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| ====Ruptured Sinus of Valsalva Aneurysm 6====
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| [[Image:Ruptured Sinus of Valsalva Aneurysm CW.jpg]]
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| ====Ruptured Sinus of Valsalva Aneurysm 7====
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| [[Image:Ruptured Sinus of Valsalva Aneurysm.jpg]]
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| ==Additional Resources==
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| {{refbegin|2}}
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| *Brabram KR, Roberts WC. Fatal intrapericardial rupture of sinus of valsalva aneurysm. Am Heart J 1990; 120 (6 Pt 1): 1455-6.
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| *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.
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| *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.
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| *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.
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| *Hurley J, McGovern E. Rupture of a sinus of valsalva aneurysm due to aspergillus endocarditis. J Cardiovasc Surg (Torino) 1994; 35 (1): 75-7.
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| *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.
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| *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.
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| *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.
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| *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.
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| *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.
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| *Sakakibara S, Konno S. Congenital aneurysm of the sinus of valsalva: anatomy and classification. Am Heart J 1962; 63: 405-24.
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| *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.
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| *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.
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| *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.
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| *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.
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| *Jeyamalar R, Kannan P. Ruptured aneurysms of the sinus of valsalva. Med J Malaya 1991; 46 (4): 371-5.
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| {{refend}}
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| {{Congenital malformations and deformations of circulatory system}}
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| {{SIB}}
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| [[Category:Pediatrics]] | | [[Category:Pediatrics]] |
| [[Category:Cardiology]] | | [[Category:Cardiology]] |
| [[Category:Congenital heart disease]] | | [[Category:Congenital heart disease]] |
| | [[Category:Disease state]] |
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| {{WH}} | | {{WH}} |
| {{WS}} | | {{WS}} |
