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Sinus of valsalva aneurysm

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http://youtu.be/ZdkFReqFwPI

http://youtu.be/ZdkFReqFwPI

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  • 1. Sinus of Valsalva Aneurysm Pre-post Tricuspid L-R shunt
  • 2. Memory lane • 1839 -1st description by Hope • 1840- 1st important paper published by Thurman • 1949- Jones and Langley -the subject of congenital and acquired lesion • 1951- 1st diagnosis of rupture during life by Venning • 1956- 1st. successful repair with CPB at Mayo Clinic using CPB. • 1957-Morrow & colleagues –closed ruptured SOVA using mild hypothermia • SAKAKIBARA & KONNO - Studied association with VSD & AR - First to provide comprehensive classification
  • 3. CONGENITAL ACQUIRED Connective tissue disorders- • VSD • Rheumatoid arthritis, • Ehlers-Danhlos syndrome, • Marfan’s syndrome, • Klippel Feil syndrome, • Turner’s syndrome, • Trisomies 13 and 15, • Loeys-Dietz syndrome, • Arachnodactyly, • Osteogenesis imperfecta. • Infectious diseases – bacterial endocarditis, syphilis, and tuberculosis; • Degenerative conditions atherosclerosis cystic medial necrosis; • Injury from deceleration trauma. • Iatrogenic pseudoaneurysms hematoma formation after AVR removal of aortic valve calcifcations
  • 4. Aetiology Congenital Acquired • VSD • Rheumatoid arthritis • Ehlers-Danhlos syndrome • Marfan’s syndrome • Klippel Feil syndrome • Turner’s syndrome • Trisomies 13 and 15 • Loeys-Dietz syndrome • Arachnodactyly • Osteogenesis imperfecta • Infectious diseases – bacterial endocarditis, syphilis, and tuberculosis; • Degenerative conditions atherosclerosis cystic medial necrosis; • Injury from deceleration trauma. • Iatrogenic pseudoaneurysms hematoma formation after AVR removal of aortic valve calcifcations
  • 5. Origin • RCC:77% • Non-CC:19% • Multiple:2.4% • left coronary sinus:0.5%
  • 6. Intact vs. rupture • 71.7% ruptured
  • 7. Exit • Most commonly into the right ventricle (67.9%) • Right atrium (27.4%) • Other rare entry sites of rupture included the left atrium, the left ventricle, the interatrial • septum, the interventricular septum and the pulmonary artery (0.5%– 1.9%)
  • 8. Sakakibara S, Konno S. Congenital aneurysm of the sinus of Valsalva. Anatomy and classification. Am Heart J 1962;63:405– 24. • 47.6% type I • 33.5% type II • 6.1% type IIIv • 12.8% type IIIa
  • 9. The SVAs arising from RCC by angiogram Sakakibara and Konno • Type I: left part of the sinus rupture or protrusion into upper portion of RVOT • Type II: central part of the sinus rupture or protrusion into mid- portion of RVOT through supraventricular crest • Type IIIv: rupture or protrusion into right ventricle near or at tricuspid annulus • Type IIIa: rupture or protrusion into right atrium
  • 10. Guo HW, Sun XG, Xu JP, et al. A new and simple classification for the non- coronary sinus of Valsalva aneurysm. Eur J Cardiothorac Surg 2011;40:1047–51:from NCC • 61.0% type I • 34.1% type IIa • 4.9% type Iiv
  • 11. Association • VSD:53.3% • RVOT obstruction :7.5% • aortic valvular malformations:5.2%
  • 12. The SVAs from the NCC by Angiogram by Guo et al • Type I: rupture or protrusion into right atrium not near the tricuspid annulus; • Type IIa: rupture or protrusion into right atrium near or at the tricuspid annulus; • Type IIv: rupture or protrusion into right ventricle near or at the tricuspid annulus
  • 13. Imaging • ECHO • Aortic root angiogram • CT aortogram
  • 14. Management • Gold: Surgery • Evolving: Transcathetor closure
  • 15. Dr Lalita/Shashikanth/Shridhar/Barik Please enjoy this memorable clip http://youtu.be/ZdkFReqFwPI

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