Transcatheter Closure of Ruptured Sinus of Valsalva

Sinus of Valsalva Aneurysm (SOVA) typically is caused by congenital weakness in the aortic wall of one of three aortic sinuses (most commonly right) and resulting in outpouching protrusion into nearby cardiac chambers. Men are more affected (4:1), and there is a higher reported incidence in Asian groups. SOVA is either congenital or acquired. Congenital ones are seen in connective tissue disorders and in some forms of congenital heart diseases, like ventricular septal defects (VSDs) and bicuspid aortic valve. Most of these defects are asymptomatic. Acquired SOVAs are seen in patients who suffered abrupt deceleration trauma; infections such as bacterial endocarditis, syphilis, and even tuberculosis and degenerative diseases. Though rare, rupture and fistulous connections with one of the adjacent cardiac chambers will give signs and symptoms of heart failure. If left untreated, the disease has poor prognosis. Multi-modality imaging plays crucial role in detecting this rare disease and in guiding management. Surgery has been traditionally the treatment of choice. However, several studies reported safety and efficacy of transcatheter treatment. In this chapter, we will discuss multiple imaging modalities implemented in diagnosis and transcatheter treatment of ruptured SOVAs, and briefly compare surgical and transcatheter treatments approach.