Erickson, Kourtney, DO

Racharla, Lekha, DO

Smith, Stacey, MD, FACP

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of MedicineInitial Management of an Asymptomatic Sinus ofValsalva Aneurysm.Lekha Racharla DOLehigh Valley Health Network, Lekha.Racharla@lvhn.orgKourtney Erickson DOLehigh Valley Health Network, Kourtney.Erickson@lvhn.orgStacey Smith MD, FACPLehigh Valley Health Network, Stacey_J.Smith@lvhn.orgFollow this and additional works at: https://scholarlyworks.lvhn.org/medicineThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtRacharla, L. Erickson, K. Smith, S. (2018, May). Initial Management of an Asymptomatic Sinus of Valsalva Aneurysm. Poster Presentedat: POMA (Philadelphia Osteopathic Medical Association), King of Prussia, PA.© 2018 Lehigh Valley Health NetworkInitial Management of an Asymptomatic Sinus  of Valsalva AneurysmLekha Racharla, DO, Kourtney Erickson, DO, Stacey Smith, MDDepartment of Medicine, Lehigh Valley Health Network, Allentown, Pa.INTRODUCTIONSinus of valsalva aneurysms are uncommon, occurring in 0.09% of the population. Congenital aneurysms are generally on the right coronary cusp and right side of the heart. Acquired aneurysms can be caused by tuberculosis, syphilis, infective endocarditis, atherosclerosis or trauma. Aneurysms are typically asymptomatic until rupture unless large enough to cause  obstructive symptoms. Ruptures classically occur during periods of exertion or trauma, and may present as chest pain, difficulty breathing, and subsequent signs of cardiac failure. Once ruptured, median survival is 1–2 years without surgical intervention.CASE PRESENTATIONA 62-year-old male presented for a routine  follow-up and was found to have a new 2/6 s ystolic ejection murmur at the upper left sternal border in September of 2014. A 2D echocardiogram revealed a sinus of  valsalva  aneurysm approximately 5cm in size. A  cardiac MRI was done to further characterize the  aneurysm which confirmed a sinus of valsalva aneurysm involving the right coronary cusp, measuring 47mm. The decision was made to monitor the aneurysm;  after approximately  2 years, the aneurysm appears to be relatively stable at 49mm. Annual monitoring will be continued and surgical repair will be reconsidered if the size progresses to > 50mm.DISCUSSION•  Diagnosis prior to rupture is generally incidental due to the asymptomatic nature of the aneurysms.•  Management and surveillance of unruptured aneurysms is not established; how ever the guidelines for aortic root aneurysm are ordinarily accepted: surgical repair should be considered with aneurysms >5.5cm, >5cm with bicuspid valves, and >4.5cm with connective tissue disease or in those with a growth of >0.5cm/year. •  Ruptures classically occur during periods of exertion or trauma, and may present as chest pain, difficulty breathing, and subsequent signs of cardiac failure: peripheral edema, low cardiac output and a machinery-type continuous murmur. However, ruptures may present with sudden cardiac death. In any patient with the acute development of congestive heart failure symptoms or continuous murmur, an echocardiogram should be obtained. If a ruptured aneurysm is discovered, immediate surgical intervention is necessary. •  Once ruptured, median survival is 1 to 2 years without surgical intervention; death is typically secondary to congestive heart failure, but infective endocarditis is reported in 8% of deaths. Surgical repair after rupture is highly successful, with 10-year survival rates around 91-95%.Primary suture closure can be done with smaller ruptures, but patch closure is the mainstay for larger ruptures. Yearly follow-up  with a cardiologist is imperative in both ruptured and unruptured groups, as is monitoring for signs and symptoms of infectious endocarditis.LEARNING POINTS•  Sinus of Valsalva aneurysms are rare and can be congenital or acquired.•  Progression and size is a predictor of rupture and risk of rupture.•  There are no guidelines for the management of asymptomatic incidental findings of Sinus of Valsalva aneurysm; however given the serious complication that could arise from its rupture, some physicians recommend operating on asymptomatic patients.REFERENCESCharitos, EI, Sievers, H.H. Anatomy of the aortic root: implications for valve sparing surgery. Ann Cardiothorac Surg 2013;2(1):53-56. DOI: 10.3978/j.issn.2225-319X.2012.11.18Vural, Kerem & Sener, E. & Tasdemir, Ozlem & Bayazit, K. (2001). Approach to sinus of Valsalva aneurysms: A review of 53 cases. European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery. 20. 71-6. 10.1016/S1010-7940(01)00758-8. Figure 1: Aortic Root AnatomyFigure 2: TTE, Parasternal Long Axis View revealing aneurysm of right coronary sinusFigure 3: Progression of aneurysm of right coronary sinus over the past 3 yearsN05637_LekhaRacharla_Poster.indd   1 5/2/18   3:54 PM

Initial Management of an Asymptomatic Sinus of Valsalva Aneurysm.

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=2526&context=medicine

Initial Management of an Asymptomatic Sinus of Valsalva Aneurysm.

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