Aneurysm of the sinus of Valsalva: a roentgenologic study of 105 Chinese patients.

Of 105 cases of lesions of the sinus of Valsalva found over a 25-year period at the Shanghai Chest Hospital, 90 were ruptured sinuses or sinus aneurysms and 15 were unruptured aneurysms. The cases were classified roentgenologically according to the method of Sakakibara and Konno: 64.5% were type I, 23.7% type II, 1.1% type IIIv, 6.4% type IIIa, 1.1% type IIIa + v, and 3.2% type IV. A new and simplified method of classification has been devised in the Shanghai Chest Hospital and shows the highest incidence to be the type of aneurysm of the sinus of Valsalva associated with ventricular septal defect. On aortography three types of morphologic changes--aneurysmal formation, enlargement of the sinus with no definite aneurysm, and sinus rupture with no enlargement or aneurysmal formation--are observed. Angiographically, shunting from ruptured sinus or sinus aneurysm begins in middiastole and gradually increases to end diastole. Aortic insufficiency, if present, usually begins in early diastole and extends over the whole diastolic phase in a decrescendo fashion. Special attention should be paid to the differentiation between ruptured sinus of Valsalva with or without aneurysmal formation and ventricular septal defect with aortic insufficiency.