http://youtu.be/ZdkFReqFwPI

1. Sinus of Valsalva Aneurysm
Pre-post Tricuspid L-R shunt

2. Memory lane
• 1839 -1st description by Hope
• 1840- 1st important paper published by Thurman
• 1949- Jones and Langley -the subject of congenital and acquired
lesion
• 1951- 1st diagnosis of rupture during life by Venning
• 1956- 1st. successful repair with CPB at Mayo Clinic using CPB.
• 1957-Morrow & colleagues –closed ruptured SOVA using mild
hypothermia
• SAKAKIBARA & KONNO
- Studied association with VSD & AR
- First to provide comprehensive classification

3. CONGENITAL ACQUIRED
Connective tissue disorders-
• VSD
• Rheumatoid arthritis,
• Ehlers-Danhlos syndrome,
• Marfan’s syndrome,
• Klippel Feil syndrome,
• Turner’s syndrome,
• Trisomies 13 and 15,
• Loeys-Dietz syndrome,
• Arachnodactyly,
• Osteogenesis imperfecta.
• Infectious diseases –
bacterial endocarditis,
syphilis, and tuberculosis;
• Degenerative conditions
atherosclerosis
cystic medial necrosis;
• Injury from deceleration trauma.
• Iatrogenic pseudoaneurysms
hematoma formation after AVR
removal of aortic valve calcifcations

4. Aetiology
Congenital Acquired
• VSD
• Rheumatoid arthritis
• Ehlers-Danhlos syndrome
• Marfan’s syndrome
• Klippel Feil syndrome
• Turner’s syndrome
• Trisomies 13 and 15
• Loeys-Dietz syndrome
• Arachnodactyly
• Osteogenesis imperfecta
• Infectious diseases –
bacterial endocarditis,
syphilis, and tuberculosis;
• Degenerative conditions
atherosclerosis
cystic medial necrosis;
• Injury from deceleration trauma.
• Iatrogenic pseudoaneurysms
hematoma formation after AVR
removal of aortic valve calcifcations

5. Origin
• RCC:77%
• Non-CC:19%
• Multiple:2.4%
• left coronary sinus:0.5%

7. Intact vs. rupture
• 71.7% ruptured

8. Exit
• Most commonly into the right ventricle (67.9%)
• Right atrium (27.4%)
• Other rare entry sites of rupture included the left atrium, the left
ventricle, the interatrial
• septum, the interventricular septum and the pulmonary artery (0.5%–
1.9%)

9. Sakakibara S, Konno S. Congenital aneurysm of the sinus of
Valsalva. Anatomy and classification. Am Heart J 1962;63:405–
24.
• 47.6% type I
• 33.5% type II
• 6.1% type IIIv
• 12.8% type IIIa

10. The SVAs arising from RCC by angiogram Sakakibara and Konno
• Type I: left part of the sinus rupture or protrusion into upper portion
of RVOT
• Type II: central part of the sinus rupture or protrusion into mid-
portion of RVOT through supraventricular crest
• Type IIIv: rupture or protrusion into right ventricle near or at tricuspid
annulus
• Type IIIa: rupture or protrusion into right atrium

12. Guo HW, Sun XG, Xu JP, et al. A new and simple classification for the non-
coronary sinus of Valsalva aneurysm. Eur J Cardiothorac Surg
2011;40:1047–51:from NCC
• 61.0% type I
• 34.1% type IIa
• 4.9% type Iiv

13. Association
• VSD:53.3%
• RVOT obstruction :7.5%
• aortic valvular malformations:5.2%

14. The SVAs from the NCC by Angiogram by Guo et al
• Type I: rupture or protrusion into right atrium not near the tricuspid
annulus;
• Type IIa: rupture or protrusion into right atrium near or at the
tricuspid annulus;
• Type IIv: rupture or protrusion into right ventricle near or at the
tricuspid annulus

15. Imaging
• ECHO
• Aortic root angiogram
• CT aortogram

16. Management
• Gold: Surgery
• Evolving: Transcathetor closure

17. Dr Lalita/Shashikanth/Shridhar/Barik
Please enjoy this memorable clip
http://youtu.be/ZdkFReqFwPI