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Letters to the Editor
Echocardiographic diagnosis of sinus of Valsalva aneurysm Suxuan Liu 1, Feng Chen 1, Xudong Xu, Xianxian Zhao ⁎,2, Yongwen Qin ⁎,2 Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China
a r t i c l e
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Article history: Received 15 May 2014 Accepted 5 July 2014 Available online 11 July 2014 Keywords: Echocardiographic diagnosis Sinus of Valsalva aneurysm Surgical treatment Percutaneous closure
Dear Editor, We read with great interest the study by Tsung O. Cheng and coworkers [1] who have shown that transthoracic echocardiography (TTE) has a specific value in the diagnosis of different pathological patterns of the sinus of Valsalva aneurysms (SVA) with distinguishing ultrasonic features. We agree with the authors that TTE is one of the most frequently used methods of diagnosis of SVA in China. Transesophageal echocardiography (TEE) will also become the investigation of choice when TTE results are questionable or in case of suspicion of SVA with other co-existing lesions. Besides, real-time 3D-TEE, contrast tomography and magnetic resonance imaging are being increasingly recommended if necessary to improve the diagnostic accuracy and clarify the co-existing malformations in some special cases [2,3]. It is well known that surgical repair is the mainstay of therapy for SVA with relatively low mortality. In recent times, successful percutaneous closure for SVA has also being increasingly reported with the advantages of minimal invasiveness, shorter time of hospital stay and so on. We once compared the outcomes of surgical and percutaneous closure for SVA and recommended that percutaneous
⁎ Corresponding authors at: Department of Cardiology, Changhai Hospital, Second Military Medical University, Changhai Road 168, Shanghai 200433, China. Tel.: + 86 213 1161248, fax: + 86 213 1161266. E-mail addresses: [email protected], [email protected] (Y. Qin). 1 Co-first authors with equal contributions. 2 Corresponding authors with equal contributions.
http://dx.doi.org/10.1016/j.ijcard.2014.07.052 0167-5273/© 2014 Elsevier Ireland Ltd. All rights reserved.
closure could be an attractive alternative to surgery in selected patients with SVA for the better clinical advantages and economic benefits [4]. TTE has an important value during the process of percutaneous closure for SVA. The occluder could only be released after making it certain that there was no significant valve regurgitation or residual shunt on TTE. The most frequent coexistence of SVA is the ventricular septal defect (VSD). An associated subarterial VSD may occasionally escape detection if the wall of the aneurysm or the prolapsing cusp of the aortic valve occludes it. Dr. Cheng et al. paid close attention to all SVA patients to routinely exclude the presence of an obstructed VSD before surgery [1]. He also mentioned that one of the major drawbacks of percutaneous closure for SVA was that it would not have the benefit of recognition of missed diagnosis and misdiagnosis as surgical treatment. However, in our experience, percutaneous closure could also provide information of diagnosis as surgery especially in case of suspicion of RSVA combined with VSD when TTE results were questionable. During the process of percutaneous closure, we routinely detected that whether the preoperative murmur vanished after the occluder was inserted and deployed in the ruptured site of aneurysm. If the murmur still existed, we would further undertake left ventriculography to exclude the existence of an associated VSD. The occluder could only be released after the murmur disappeared during auscultation and no left to right shunt was observed by left ventriculography. In conclusion, TTE could provide precise information of SVA for both surgical and percutaneous treatment. TTE also has a specific value during the process of percutaneous closure for SVA. We should pay more attention to further improve the diagnostic accuracy of TTE for SVA. References [1] Cheng TO, Yang YL, Xie MX, et al. 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. Int J Cardiol 2014;173:33–9. [2] Vatankulu MA, Tasal A, Erdogan E, Sonmez O, Goktekin O. The role of threedimensional echocardiography in diagnosis and management of ruptured sinus of Valsalva aneurysm. Echocardiography 2013;30:E260–2. [3] Hoey ET, Gulati GS, Singh S, et al. The role of multi-modality imaging for sinus of Valsalva aneurysms. Int J Cardiovasc Imaging 2012;28:1725–38. [4] Liu S, Xu X, Ding X, et al. Comparison of immediate results and mid-term follow-up of surgical and percutaneous closure of ruptured sinus of Valsalva aneurysm. J Cardiol 2014;63:239–43.
Letters to the Editor
Echocardiographic diagnosis of sinus of Valsalva aneurysm Suxuan Liu 1, Feng Chen 1, Xudong Xu, Xianxian Zhao ⁎,2, Yongwen Qin ⁎,2 Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China
a r t i c l e
i n f o
Article history: Received 15 May 2014 Accepted 5 July 2014 Available online 11 July 2014 Keywords: Echocardiographic diagnosis Sinus of Valsalva aneurysm Surgical treatment Percutaneous closure
Dear Editor, We read with great interest the study by Tsung O. Cheng and coworkers [1] who have shown that transthoracic echocardiography (TTE) has a specific value in the diagnosis of different pathological patterns of the sinus of Valsalva aneurysms (SVA) with distinguishing ultrasonic features. We agree with the authors that TTE is one of the most frequently used methods of diagnosis of SVA in China. Transesophageal echocardiography (TEE) will also become the investigation of choice when TTE results are questionable or in case of suspicion of SVA with other co-existing lesions. Besides, real-time 3D-TEE, contrast tomography and magnetic resonance imaging are being increasingly recommended if necessary to improve the diagnostic accuracy and clarify the co-existing malformations in some special cases [2,3]. It is well known that surgical repair is the mainstay of therapy for SVA with relatively low mortality. In recent times, successful percutaneous closure for SVA has also being increasingly reported with the advantages of minimal invasiveness, shorter time of hospital stay and so on. We once compared the outcomes of surgical and percutaneous closure for SVA and recommended that percutaneous
⁎ Corresponding authors at: Department of Cardiology, Changhai Hospital, Second Military Medical University, Changhai Road 168, Shanghai 200433, China. Tel.: + 86 213 1161248, fax: + 86 213 1161266. E-mail addresses: [email protected], [email protected] (Y. Qin). 1 Co-first authors with equal contributions. 2 Corresponding authors with equal contributions.
http://dx.doi.org/10.1016/j.ijcard.2014.07.052 0167-5273/© 2014 Elsevier Ireland Ltd. All rights reserved.
closure could be an attractive alternative to surgery in selected patients with SVA for the better clinical advantages and economic benefits [4]. TTE has an important value during the process of percutaneous closure for SVA. The occluder could only be released after making it certain that there was no significant valve regurgitation or residual shunt on TTE. The most frequent coexistence of SVA is the ventricular septal defect (VSD). An associated subarterial VSD may occasionally escape detection if the wall of the aneurysm or the prolapsing cusp of the aortic valve occludes it. Dr. Cheng et al. paid close attention to all SVA patients to routinely exclude the presence of an obstructed VSD before surgery [1]. He also mentioned that one of the major drawbacks of percutaneous closure for SVA was that it would not have the benefit of recognition of missed diagnosis and misdiagnosis as surgical treatment. However, in our experience, percutaneous closure could also provide information of diagnosis as surgery especially in case of suspicion of RSVA combined with VSD when TTE results were questionable. During the process of percutaneous closure, we routinely detected that whether the preoperative murmur vanished after the occluder was inserted and deployed in the ruptured site of aneurysm. If the murmur still existed, we would further undertake left ventriculography to exclude the existence of an associated VSD. The occluder could only be released after the murmur disappeared during auscultation and no left to right shunt was observed by left ventriculography. In conclusion, TTE could provide precise information of SVA for both surgical and percutaneous treatment. TTE also has a specific value during the process of percutaneous closure for SVA. We should pay more attention to further improve the diagnostic accuracy of TTE for SVA. References [1] Cheng TO, Yang YL, Xie MX, et al. 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. Int J Cardiol 2014;173:33–9. [2] Vatankulu MA, Tasal A, Erdogan E, Sonmez O, Goktekin O. The role of threedimensional echocardiography in diagnosis and management of ruptured sinus of Valsalva aneurysm. Echocardiography 2013;30:E260–2. [3] Hoey ET, Gulati GS, Singh S, et al. The role of multi-modality imaging for sinus of Valsalva aneurysms. Int J Cardiovasc Imaging 2012;28:1725–38. [4] Liu S, Xu X, Ding X, et al. Comparison of immediate results and mid-term follow-up of surgical and percutaneous closure of ruptured sinus of Valsalva aneurysm. J Cardiol 2014;63:239–43.
