Echocardiographic diagnosis of sinus of Valsalva aneurysm: A 17-year (1995–2012) experience of 212 surgically treated patients from one single medical center in China

• Published in: International journal of cardiology 2014-04, Vol.173 (1), p.33-39
• Main Authors: Cheng, Tsung O, Yang, Ya-Li, Xie, Ming-Xing, Wang, Xin-Fang, Dong, Nian-Guo, Su, Wei, Lü, Qing, He, Lin, Lu, Xiao-Fang, Wang, Jing, Li, Ling, Yuan, Li
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aortic Aneurysm - diagnostic imaging; Aortic Aneurysm - epidemiology; Aortic Aneurysm - surgery; Aortic Rupture - diagnostic imaging; Aortic Rupture - epidemiology; Aortic Rupture - surgery; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cardiovascular; Cardiovascular system; Child; Child, Preschool; China - epidemiology; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Echocardiographic diagnosis; Echocardiography - methods; Female; Heart; Humans; Infant; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Retrospective Studies; Sinus of Valsalva - diagnostic imaging; Sinus of Valsalva - surgery; Sinus of Valsalva aneurysm; Surgical treatment; Treatment Outcome; Ultrasonic investigative techniques; Young Adult
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2014.02.003

Abstract Objective To evaluate the value of echocardiography in the diagnosis of different pathological patterns of sinus of Valsalva aneurysms (SVAs). Methods Echocardiographic features and surgical findings of 212 consecutive patients with SVAs treated in the last 17 years (1995–2012) at the Union Hospital of Huazhong University of Science and Technology were compared and analyzed retrospectively. Results 212 Chinese patients with SVAs underwent surgical repairs from January 1995 to May 2012 in our hospital. The aneurysms originated from the right, non-, multiple and left coronary sinus in 77.8%, 19.3%, 2.4% and 0.5%, respectively. 71.7% were ruptured, most commonly into the right ventricle (67.9%) followed by the 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%). 164 SVAs arising from the right coronary sinus were classified by the Sakakibara method: 47.6% type I, 33.5% type II, 6.1% type IIIv and 12.8% type IIIa. 41 aneurysms of the non-coronary sinus were classified by the Guo method: 61.0% type I, 34.1% type IIa and 4.9% type IIv. The three most common associated cardiovascular lesions were ventricular septal defect (VSD) (53.3%), stenosis of right ventricular outflow tract (RVOTS) (7.5%) and aortic valvular malformations (5.2%). Compared with surgical results, the sensitivity, specificity and accuracy of echocardiographic diagnosis of SVAs were 93.9%, 99.9% and 99.8%, respectively. Of the 13 SVAs that were missed on echocardiography, 77% were small aneurysms of the right coronary sinus extending into the right ventricle across a VSD. Of the 199 cases diagnosed by echocardiography prior to surgery, the diagnostic accuracy of aneurismal origination, termination and whether ruptured or not was 99.0%, 99.0% and 97.5%, respectively. Echocardiography also diagnosed accurately all of the complications of the SVAs with the exception of aneurismal vegetations. The sensitivity, specificity and accuracy of echocardiography in diagnosing the associated cardiovascular lesions were 89.2%, 99.9% and 99.0%, respectively. The most common misdiagnosis and misdiagnosed associated lesions were the RVOTS and the types of VSD, respectively. Conclusions Echocardiography has a specific value in the diagnosis of different pathological patterns of the SVAs with distinguishing ultrasonic features. To the best of our knowledge, this is th