Zhang W J, Yang Y L, Xie M X, Wang X F, Lyu Q, He L, Wang J, Li L, Zhang J, Wang Y, Liu J F
Department of Ultrasonography, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2016 Jun 24;44(6):513-7. doi: 10.3760/cma.j.issn.0253-3758.2016.06.011.
To observe image features of sinus of Valsalva aneurysm (SVA) extending into left ventricle by echocardiography.
Echocardiographic features of 5 cases of SVA extending into left ventricle and underwent surgery at Union Hospital from July 1995 to September 2015 were reviewed retrospectively and image and surgical findings were compared. A total of 4 patients were diagnosed by conventional and 3D echocardiography before surgery, and 1 patient was diagnosed by conventional echocardiography.
The origin, extending position, rupture status, complications of the SVA and associated cardiovascular lesions determined by echocardiography were entirely consistent with surgical findings in all cases, with the exception of one failed diagnosis of hypoplasty of an adjacent aortic cusp. Besides the common features of SVA, echocardiographic features of SVA extending into left ventricle included a thin-walled saccular lesion arising from the aortic root in continuation with the aortic annulus, with significant morphological changes and movement. Moreover, following features were observed: very low origin of the saccular lesion arising between the sinus base and the aortic annulus; the aneurysm going back and forth between the aortic root and the left ventricular outflow tract in 4 cases with an intact interventricular septum, and between the left ventricle and the right ventricle through the septal defect in another case complicated by a huge ventricular septal defect; diastolic shunt into the left ventricle when ruptured; displacement of the adjacent aortic annulus due to compression of aneurismal origin and prolapse of both aortic valve and annulus observed in all cases, resulting in a severe aortic regurgitation; obstructions of the left ventricular outflow tract due to the space-occupying effect were also found in 2 cases.
The SVA extending into left ventricle has distinguished echocardiographic characteristics, which could be accurately diagnosed either by conventional or real-time 3D echocardiography.
通过超声心动图观察累及左心室的主动脉窦瘤（SVA）的影像特征。
回顾性分析1995年7月至2015年9月在协和医院接受手术的5例累及左心室的SVA患者的超声心动图特征，并比较影像和手术结果。术前共有4例患者通过传统超声心动图和三维超声心动图确诊，1例患者通过传统超声心动图确诊。
超声心动图确定的SVA的起源、延伸位置、破裂状态、并发症及相关心血管病变在所有病例中均与手术结果完全一致，但有1例漏诊相邻主动脉瓣叶发育不全。除SVA的常见特征外，累及左心室的SVA的超声心动图特征还包括一个薄壁囊状病变，起源于主动脉根部并与主动脉瓣环相连，形态有明显改变且有活动。此外，还观察到以下特征：囊状病变起源极低，位于窦底部与主动脉瓣环之间；4例室间隔完整的患者，瘤体在主动脉根部与左心室流出道之间来回移动，1例合并巨大室间隔缺损的患者，瘤体通过室间隔缺损在左心室与右心室之间移动；破裂时舒张期分流至左心室；所有病例均观察到由于瘤体起源处受压导致相邻主动脉瓣环移位，主动脉瓣和瓣环脱垂，导致严重主动脉瓣反流；2例患者还因占位效应出现左心室流出道梗阻。
累及左心室的SVA具有独特的超声心动图特征，传统或实时三维超声心动图均可准确诊断。
