A sinus of Valsalva aneurysm (SVA) is an uncommon congenital malformation. SVAs arise mostly from the right and non-coronary sinuses and rarely from the left coronary sinus (LCS) or multiple sinuses. When SVA ruptures, it is more apt to enter the right ventricle (RV), followed by the right atrium (RA).
Echocardiography is currently the diagnostic modality of choice for the evaluation of SVAs. Sometimes operator inexperience makes it easy to misdiagnose or to fail to diagnose SVAs. A retrospective study was done to compare the echocardiographic features and surgical findings of SVA patients with rare patterns to evaluate the diagnostic value of echocardiography and discussed the improvement of diagnostic accuracy.
Echocardiographic features and surgical findings from 270 Chinese patients with SVA treated in the last 18 years (1995–2013) at the Union Hospital were compared retrospectively; 22 of 270 cases had rare patterns.
The patients with SVA, a rare origin, a rare extending position, or a rare course accounted for 3.4%, 7.4%, and 0.4% of the 270 cases, respectively. The three most common aneurysmal complications of the patients with rare patterns were severe aortic regurgitation, obstruction of the ventricular outflow tract or valvular orifice, and conduction disturbance.
The origin, course, extending position and rupture status of the SVAs determined by echocardiography were entirely consistent with surgical findings in 81.8% of the 22 cases. With the exception of one failed diagnosis of an aneurysmal wall dissection and one misdiagnosis of a descending aortic dissection, the echocardiographic results of SVA complications and associated cardiovascular lesions were also confirmed.
In patients with SVA with rare patterns, special image characteristics that are noticeably different from those observed in the more common conditions were found because of the unique protrusion position, complex origin, tortuous course, or rare complication. Making a diagnosis is a challenge, especially for less experienced ultrasonographers. Therefore, to improve diagnostic accuracy, an experientially based comprehensive grasp of the criteria for ultrasonographic and differential diagnosis of these special SVA patterns is extremely important.
An accurate diagnose SVAs with rare pathological patterns by echocardiographic identification of distinguishing features can be done. But for several conditions, we could not accurately identify the origin or course of the aneurysm or define its relationship to adjacent structures using conventional echocardiography alone. Therefore, it was recommended that combining conventional echocardiography with different imaging techniques, such as transesophageal echocardiography, three-dimensional echocardiography, computed tomography angiography, and aortic angiography.