Bass David, Sharma Sanjeev, Alahmadi Mohamed H., Tivakaran Vijai S.
Hofstra School of Medicine
University of Health Sciences, Lahore
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.
瓦氏窦瘤（SOVA）是一种罕见的心脏疾病，包括主动脉根部在主动脉瓣环和窦管交界处之间的异常扩张，这是由主动脉中膜与纤维环交界处的弹性层薄弱引起的。通常，在主动脉瓣开放的收缩期，窦部可防止冠状动脉开口闭塞。男性正常窦直径小于4厘米，女性小于3.6厘米（见瓦氏窦瘤）。大多数瓦氏窦瘤仍位于心腔内，向一个心腔突出，但一小部分可能会延伸至心腔外。虽然瓦氏窦瘤通常是孤立的，但罕见情况下会涉及两个或三个窦的动脉瘤。瓦氏窦瘤最常见于右冠状动脉窦（70%），通常在破裂进入附近结构之前无症状。心腔内的动脉瘤性窦可破裂进入相邻心腔，破裂的具体位置取决于瓦氏窦瘤的位置：右、左和无冠状动脉窦分别与室间隔、左心室游离壁和房间隔相邻。这些解剖学上的邻近关系有助于根据瓦氏窦瘤的位置解释破裂的起源。这种破裂在主动脉和心腔之间形成了一个通道，导致进行性心力衰竭。未经治疗，瓦氏窦瘤破裂的患者预后不良，死亡率高，因此及时干预至关重要。任何瓦氏窦瘤的诊断都应促使紧急转诊至心胸外科医生处，考虑进行修复。瓦氏窦瘤在接受心脏手术的患者中发生率约为0.2%至0.9%。瓦氏窦瘤可以是先天性的，也可以是后天获得的；先天性瓦氏窦瘤最常见于亚洲血统的男性，是由球嵴异常发育引起的，常与室间隔缺损、主动脉瓣关闭不全和二叶主动脉瓣等异常并存。后天获得性瓦氏窦瘤可能与既往手术、动脉粥样硬化、心内膜炎、梅毒和其他形式的创伤有关。
