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. 2021 Jun;11(3):770-780.
doi: 10.21037/cdt-20-630.

Outcomes of contemporary imaging-guided management of sinus of Valsalva aneurysms

Bo Xu  1 , Duygu Kocyigit  1 , Carlos Godoy-Rivas  2 , Jorge Betancor  3 , L Leonardo Rodriguez  1 , Venu Menon  4 , Wael Jaber  1 , Richard Grimm  1 , Scott D Flamm  5 , Paul Schoenhagen  5 , Lars G Svensson  6 , Brian P Griffin  1
Affiliations

Outcomes of contemporary imaging-guided management of sinus of Valsalva aneurysms

Bo Xu et al. Cardiovasc Diagn Ther. 2021 Jun.

Abstract

Background: Sinus of Valsalva aneurysms (SVAs) are rare. We assessed the role of multimodality imaging in guiding the contemporary management.

Methods: A single-center retrospective cohort study over a 20-year period was performed.

Results: Between January 1997 and June 2017, 103 patients were diagnosed with SVAs (median age: 58 years). Eighty patients presented with non-ruptured SVAs, and 23 with ruptured SVAs. Seventy-six patients underwent surgery, and 27 were conservatively managed. The median durations of follow-up were: 48 months (surgical group) vs. 37.5 months (conservative group). There was no mortality directly attributable to SVA surgery. There were no late complications in the conservative group. Transthoracic echocardiography (TTE) was the first-line imaging investigation (100.0% in surgical group vs. 92.6% in conservative group, P=0.019). Additional imaging studies included: (I) transesophageal echocardiography (TEE): 93.4% in surgical group vs. 22.2% in conservative group, P<0.001; (II) multi-detector cardiac computed tomography (MDCT): 61.8% in surgical group vs. 37.0% in conservative group, P=0.041; (III) cardiac magnetic resonance (CMR): 22.4% in surgical group vs. 14.8% in conservative group, P=0.579. At diagnosis, SVA diameters were: TTE: 4.80 cm (range, 3.30 cm); TEE: 5.40 cm (range, 4.00 cm); MDCT: 5.20 cm (range, 3.90 cm); CMR: 4.80 cm (range, 3.70 cm).

Conclusions: In a 20-year cohort, proper selection for surgery and conservative management resulted in excellent outcomes for SVAs. TTE was the first-line imaging investigation for assessment of SVAs, although many patients underwent an additional imaging investigation. The contemporary outcomes of imaging-guided SVA management were excellent.

Keywords: Sinus of Valsalva aneurysm (SVA); cardiac magnetic resonance imaging; cardiac surgery; multidetector cardiac computed tomography; multimodality imaging; transthoracic echocardiography.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/cdt-20-630). The series “Heart Valve Disease” was commissioned by the editorial office without any funding or sponsorship. PS serves as the Editor- In-Chief of Cardiovascular Diagnosis and Therapy. BX served as the unpaid Guest Editor of the series. DK reports that she received a personal non-commercial grant from the Turkish Society of Cardiology, outside the submitted work. SDF reports personal fees from Renova Therapeutics, Inc., Precision Image Analysis, Inc. and serves in a fiduciary capacity, such as an elected officer, director, or chief medical officer, for Cryothermic Systems, Inc. and Precision Image Analysis, Inc., outside the submitted work. LGS reports to receive or have the right to receive royalty payments for inventions or discoveries commercialized through Posthorax GmbH, outside the submitted work. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
An illustrative example of a large right sinus of Valsalva aneurysm is shown to demonstrate sinus-to-sinus vs. sinus-to-commissure methods for measuring sinuses of Valsalva diameters by multidetector cardiac computed tomography.
Figure 2
Figure 2
Distribution of the number of SVAs diagnosed per year over the study period between 1997 and 2017. SVA, sinus of Valsalva aneurysm.
Figure 3
Figure 3
Distribution of the different types of SVAs in the study cohort. The cases are further stratified by presence of rupture at presentation and management strategy (conservative vs. surgical). Five patients in the right coronary SVA group had another sinus involvement: accompanying non-coronary SVA in 2 patients, and left coronary SVA in 3 patients. SVA, sinus of Valsalva aneurysm.
Figure 4
Figure 4
Kaplan-Meier survival analysis of SVA patients, stratified by management strategy: Blue curve—patients who underwent surgical management (n=73, 7 events); yellow curve—patients who underwent conservative management (n=26, 8 events). Note that follow-up data for the purpose of Kaplan-Meier analysis were based on 99 cases, since four patients were lost to follow-up (no subsequent clinic visits, and the mortality status was unknown). SVA, sinus of Valsalva aneurysm.
Figure 5
Figure 5
Comparison of SVA measurements using multimodality cardiovascular imaging in the conservative vs. surgical groups. A comparison for TEE is not shown, because there were only two patients undergoing TEE in the conservative management group. CMR, cardiac magnetic resonance; MDCT, multidetector computed tomography; SVA, sinus of Valsalva aneurysm; TTE, transthoracic echocardiography.
See this image and copyright information in PMC

References

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