Sinus of Valsalva Aneurysm

A sinus of Valsalva aneurysm (SOVA) is a rare cardiac condition that includes an abnormal dilatation of the aortic root between the aortic valve annulus and the sinotubular junction caused by weakness in the elastic lamina at the junction of the aortic media and the annulus fibrosus. Usually, the sinuses prevent the coronary artery ostia occlusion during systole when the aortic valve opens. The normal sinus diameter is less than 4 cm for men and 3.6 cm for women (see Sinus of Valsalva Aneurysm). Most of the SOVAs remain intracardiac, outpouching into 1 of the heart chambers, but a small fraction may become extracardiac. While SOVAs are usually isolated, rare cases involve aneurysms in 2 or 3 sinuses. A SOVA most commonly occurs in the right coronary sinus (70%) and typically remains asymptomatic until it ruptures into nearby structures. The intracardiac aneurysmal sinus can rupture into an adjacent heart chamber, and the specific location of the rupture depends on the SOVA's position: the right, left, and noncoronary sinuses are adjacent to the interventricular septum, left ventricular free wall, and interatrial septum, respectively. These anatomical proximities help explain the rupture's origin based on the SOVA's location.  This rupture creates a communication between the aorta and the heart chamber, leading to progressive heart failure. Without treatment, patients with a ruptured SOVA face poor prognoses and high mortality rates, making timely intervention essential. Any diagnosis of SOVA should prompt an urgent referral to a cardiothoracic surgeon for consideration of repair. SOVAs occur in approximately 0.2% to 0.9% of patients who have had cardiac surgery. SOVA can be either congenital or acquired; congenital SOVA, most commonly seen in men of Asian descent, results from abnormal development of the bulbus cordis and often coexists with anomalies like ventricular septal defect, aortic insufficiency, and bicuspid aortic valve. Acquired SOVA can be linked to prior surgeries, atherosclerosis, endocarditis, syphilis, and other forms of trauma.