Rupture of the Sinus of Valsalva

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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


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

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 treatment for [disease name]; the mainstay of therapy is supportive care.

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].

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].

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

  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.
  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.
  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.
  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.
  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.
  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.
  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.
  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)



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