Management of Sinus of Valsalva Aneurysms and Associated Cardiac Defects

Sinus of Valsalva aneurysms (SVAs) are uncommon dilatations of the aortic root that may occur congenitally or be acquired through infection, trauma or degenerative changes. They frequently coexist with ventricular septal defects, aortic regurgitation or fistulae into cardiac chambers. Presentations range from an incidental murmur to sudden heart failure when rupture occurs. Diagnosis relies on transthoracic and transoesophageal echocardiography, augmented by computed tomography or magnetic resonance imaging for detailed anatomy. Management is guided by aneurysm size, rupture status and associated lesions. Urgent surgical repair remains the standard for ruptured or high-risk unruptured aneurysms, combining patch closure of the aneurysmal sinus with correction of accompanying defects under cardiopulmonary bypass. Beating-heart techniques have been developed to maintain coronary perfusion and reduce ischaemia-reperfusion injury. In selected high-risk patients, percutaneous closure devices offer a less invasive alternative. Lifelong follow-up is essential to monitor for recurrent dilatation, valvular dysfunction and ventricular performance. A multidisciplinary team approach ensures timely intervention and individualised care.

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Management of Sinus of Valsalva Aneurysms and Associated Cardiac Defects publication trend

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Technical terms

Sinus of Valsalva aneurysm: A focal bulge in one of the three aortic sinuses at the root of the aorta.

Aorto-atrial fistula: An abnormal channel between the aorta and an atrium, often resulting from aneurysm rupture.

Echocardiography: Ultrasound imaging modality for visualising cardiac structures and blood flow.

Cardioplegia: Pharmacological arrest of the heart to protect myocardium during surgery.

Shunt: Abnormal passage allowing blood flow between cardiac chambers or vessels.

References

1. Acute rupture of a sinus of Valsalva aneurysm into the right atrium: a case report and a narrative review. BMC Cardiovascular Disorders (2020).
2. Surgical correction of ruptured aneurysms of the sinus of Valsalva using on-pump beating-heart technique. Journal of Cardiothoracic Surgery (2010).
3. Infective endocarditis of an aorto-right atrial fistula caused by asymptomatic rupture of a sinus of Valsalva aneurysm: a case report. Surgical Case Reports (2016).