Outcomes of contemporary imaging-guided management of sinus of Valsalva aneurysms

Bo Xu; Duygu Kocyigit; Carlos Godoy-Rivas; Jorge Betancor; L Leonardo Rodriguez; Venu Menon; Wael Jaber; Richard Grimm; Scott D Flamm; Paul Schoenhagen; Lars G Svensson; Brian P Griffin

doi:10.21037/cdt-20-630

Outcomes of contemporary imaging-guided management of sinus of Valsalva aneurysms

Cardiovasc Diagn Ther. 2021 Jun;11(3):770-780. doi: 10.21037/cdt-20-630.

Authors

Affiliations

¹ Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
² University of Connecticut Health Center, Farmington, CT, USA.
³ Aventura Hospital and Medical Center, Aventura, FL, USA.
⁴ Section of Clinical Cardiology, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
⁵ Cardiovascular Imaging Laboratory, Imaging Institute, and Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
⁶ Department of Thoracic and Cardiovascular Surgery, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.

Abstract

Background: Sinus of Valsalva aneurysms (SVAs) are rare. We assessed the role of multimodality imaging in guiding the contemporary management.

Methods: A single-center retrospective cohort study over a 20-year period was performed.

Results: Between January 1997 and June 2017, 103 patients were diagnosed with SVAs (median age: 58 years). Eighty patients presented with non-ruptured SVAs, and 23 with ruptured SVAs. Seventy-six patients underwent surgery, and 27 were conservatively managed. The median durations of follow-up were: 48 months (surgical group) vs. 37.5 months (conservative group). There was no mortality directly attributable to SVA surgery. There were no late complications in the conservative group. Transthoracic echocardiography (TTE) was the first-line imaging investigation (100.0% in surgical group vs. 92.6% in conservative group, P=0.019). Additional imaging studies included: (I) transesophageal echocardiography (TEE): 93.4% in surgical group vs. 22.2% in conservative group, P<0.001; (II) multi-detector cardiac computed tomography (MDCT): 61.8% in surgical group vs. 37.0% in conservative group, P=0.041; (III) cardiac magnetic resonance (CMR): 22.4% in surgical group vs. 14.8% in conservative group, P=0.579. At diagnosis, SVA diameters were: TTE: 4.80 cm (range, 3.30 cm); TEE: 5.40 cm (range, 4.00 cm); MDCT: 5.20 cm (range, 3.90 cm); CMR: 4.80 cm (range, 3.70 cm).

Conclusions: In a 20-year cohort, proper selection for surgery and conservative management resulted in excellent outcomes for SVAs. TTE was the first-line imaging investigation for assessment of SVAs, although many patients underwent an additional imaging investigation. The contemporary outcomes of imaging-guided SVA management were excellent.

Keywords: Sinus of Valsalva aneurysm (SVA); cardiac magnetic resonance imaging; cardiac surgery; multidetector cardiac computed tomography; multimodality imaging; transthoracic echocardiography.