Congenital aneurysm of the sinus of valsalva. Aneurysm of the sinuses of Valsalva: timely surgery - a successful solution to the problem

Aneurysm of the sinus of Valsalva (SVA) is a congenital anomaly of the aortic root, characterized by protrusion of the wall of the coronary sinus, often with a breakthrough into the presenting parts of the heart. The prevalence is 0.1-3.5% of the total number of cases of congenital heart defects (CHD). In this case, an aneurysm of the right coronary sinus occurs, according to various authors, in 75-95% of cases. Most often, an aneurysm ruptures into the cavity of the right atrium, less often into the right ventricle. Isolated cases of ASV breakthrough into the pulmonary artery, left atrium, left ventricle, and pericardium have also been described.

Treatment is surgical and consists of resection of the aneurysm under artificial circulation.

As a clinical example from our practice, we present a case of diagnosis and successful surgical treatment of an aneurysm of the right sinus of Valsalva with a breakthrough into the cavity of the right ventricle.

Patient F., 49 years old, was admitted to the Republican Cardiology Clinic with complaints of pressing pain in the chest when walking on level ground for 100 meters, climbing to the 1st floor, relieved with rest after 5 minutes, severe shortness of breath with little physical activity, short-term interruptions in heart function, increased blood pressure to 170/90 mm Hg. Art., accompanied by headache, general weakness.

Over the past 2 years, he has noted a feeling of discomfort, pain in the chest, shortness of breath with moderate physical activity. A sharp deterioration in his condition on July 22, 2014, when a patient with symptoms of a prolonged anginal attack was taken via line “03” to City Clinical Hospital No. 1 in Cheboksary. The symptoms of heart failure were compensated conservatively. On August 4, 2014, repeated anginal attack at rest, blood pressure decreased to 90/70 mm Hg. Art. Cardiac-specific tests are negative, D-dimer is negative, according to CT OGK there are signs of congestive pneumonia, bilateral hydrothorax. According to echocardiography (EchoCG), splitting of the pericardial layers, expansion of the sinus of Valsalva up to 40 mm. The patient was transferred to the RKD hospital.

The general condition upon admission to the RKD BU is serious. Consciousness is inhibited. The patient has a hypersthenic build. Height 165 cm, weight 85 kg, body mass index - 31.2. The body structure is correct. Increased development of subcutaneous tissue. There is no swelling. The color of the skin is pale. The color of the mucous membranes is pale pink. The tongue is clean and moist. Lymph nodes are not enlarged. The muscles are painless on palpation. The chest is of the correct shape. The respiratory rate is 20 per minute. Breathing is vesicular, weakened in the lower sections on both sides. Wheezing is heard in the lower parts of the lungs on both sides. Heart sounds are muffled and rhythmic. Heart rate - 94 beats/min. Heart murmurs: rough systole-diastolic murmur at the Botkin-Erb point, carried out to all auscultatory points, accent of the 2nd tone over the aorta. Blood pressure: on the left arm - 130/80 mm Hg. Art., on the right hand - 130/80 mm Hg. Art. Pulse of satisfactory filling - 94 beats/min. Liver along the edge of the costal arch. The spleen is not palpable. The abdomen is soft and painless on palpation. Urine flow is free. Diuresis is sufficient. The effleurage symptom is negative on both sides.

According to echocardiography: left ventricle (LV) - end-diastolic dimension (EDD) 5.60 cm, end-systolic dimension (ESD) 3.50 cm, end-diastolic volume 153.66 ml, end-systolic volume 50.87 ml, stroke volume 102.80 ml, ejection fraction 66.90%, shortening fraction 37.50%. The LV cavity is not enlarged. According to the ejection fraction, LV contractility is preserved. There is an additional chord in the LV cavity. The posterior wall of the LV and the interventricular septum are not thickened in diastole. The mass of the LV myocardium is within normal limits. In the subaortic region, the flow of left-right discharge is 3-4 mm wide. Right ventricle (RV) at the level of the tricuspid valve (TV) EDV 3.50 cm. The RV cavity is not expanded, without structural disturbances. Left atrium (LA) - ESR 4.90. Enlargement of the LA cavity, 1st degree. The right atrium, the upper-inferior size is 5.90 cm, is enlarged, the medial-lateral size is 4.90 cm, it is increased. The interatrial septum is without features. Aorta - the diameter of the fibrous ring is 2.30 cm - not increased, the diameter at the level of the sinus of Valsalva is 3.70 cm - increased, the diameter at the level of the ascending limb is 3.20 cm - within normal limits. The right coronary sinus is aneurysmically dilated 13*10 mm with a flow of left-right discharge into the pancreatic cavity up to 12 mm. Aortic valve - systolic divergence of the valves is within normal limits. Atherosclerotic densified crescents. Aortic regurgitation flow stage 1. Mitral valve - diameter of the fibrous ring is 3.30 cm. Mitral regurgitation 1st degree. tricuspid valve - the diameter of the fibrous ring is 3.50 cm, the degree of pulmonary hypertension according to the systolic gradient through the TC is 50.0. Systolic pressure in the pulmonary artery (PA) 55.00 mm Hg. Art. PA valve - blood flow speed 2.10 - increased.

A diagnosis was made: Aneurysm of the right sinus of Valsalva with rupture into the right ventricle.

After stabilizing the general condition and carrying out the necessary set of diagnostic measures, the patient underwent surgical treatment. Taking into account the nature of the defect and the clinical picture of heart failure, a decision was made to surgically correct the defect under conditions of artificial circulation, hypothermia and pharmacocold cardioplegia.

During the operation, access to the heart was achieved using a median sternotomy. The pericardium is widely opened. The aorta and vena cava were cannulated according to the accepted technique. The heart-lung machine was connected and hypothermic perfusion was started. A longitudinal ventriculotomy was performed on the right. During inspection, a bulging of the wall of the right sinus of Valsalva measuring 30*30 mm, with a breakthrough, was revealed in the pancreatic cavity. The aneurysmal formation was resected, and the resulting hole was sutured with separate U-shaped sutures reinforced with gaskets. The wound of the wall of the right ventricle is sutured with a double-row suture on pads. Cardiac activity was restored after two defibrillator shocks.

The postoperative course is smooth. The wound healed by primary intention. The control echocardiography revealed no signs of left-to-right shunting. The patient was discharged on the 13th day after surgery in satisfactory condition.

It can be assumed that the sharp deterioration in our patient’s health was associated with the rupture of the aneurysm into the cavity of the right ventricle. After an episode of acute disturbance of intracardiac hemodynamics, the inclusion of compensatory mechanisms allowed the body to adapt to new pathological features of blood circulation. However, such a favorable scenario for the development of events is an exception to the rule; most patients with ruptured ASV die, and the diagnosis is made based on the results of a pathological examination. EchoCG is traditionally considered the “gold standard” for diagnosing ASV, however, in some cases, an atypical ultrasound picture complicates the differential diagnosis of the disease, which requires the use of additional diagnostic methods, such as computed tomography, magnetic resonance imaging, and angiography. The use of modern research methods makes it possible to make the correct diagnosis and promptly perform surgical correction of the defect.

The sinuses (sinuses) of the aorta at the site of attachment of the semilunar valves of the aortic valve are named after the Italian anatomist Valsalva. With aneurysmal expansion of the wall in this area, a heart defect occurs, most often due to congenital weakness of the connective tissue.

The manifestation of signs of the disease occurs when an aneurysm ruptures - chest pain, a drop in cardiac activity. Treatment requires angioplasty using a heart-lung machine.

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Reasons for development

Congenital aortic aneurysm in the area of the sinuses of Valsalva is the most common variant of this pathology; it is found more often in boys. All three sinuses can be affected, but in the vast majority it is the right coronary sinus. The size of the formation varies from 1 to 3 cm.

Isolated bulging of a vessel in the root zone is rare; patients usually suffer from, or, narrowing of the pulmonary artery.

The formation of this aortic defect is caused by the influence of unfavorable factors on a pregnant woman:

viral infections,
syphilis,
diabetes,
intoxication,
medicines,
taking alcohol or drugs,
smoking,
harmful working conditions,
toxicosis,
threat of miscarriage.

The formation of the congenital defect is based on the weakening of elastin fibers at the site of attachment of the aorta to the valve ring. This occurs during the period of intrauterine development. After birth, there is no aneurysm, and as it grows, the wall of the vessel becomes thin and ruptures under the influence of blood pressure.

Such an event can occur in childhood, but most often patients live to be 20–30 years old, unaware of their illness.

Acquired pathology is formed after suffering tuberculosis, syphilitic or rheumatic infection, against the background of traumatic injury. With a strong blow to the chest, the aneurysm can rupture with the passage of blood into the cavity of the pericardial sac. This causes death almost instantly.

Symptoms of sinus of Valsalva aneurysm

Many patients do not have cardiac dysfunction until the moment of rupture. Sometimes an aneurysm interferes with the free flow of blood through the pulmonary artery or compresses conductive fibers in the myocardium, causing various types.

The rupture of the aneurysmal sac occurs in the heart cavity. This leads to the discharge of blood into the corresponding chamber. If the formation is located in the right or left coronary sinus, then the half of the heart of the same name becomes full. The non-coronary sinus is close to the right atrium, so the aneurysm ruptures into it.

The course of the defect may be with a gradual increase in clinical signs. This is only possible with the simultaneous development of another congenital anomaly of the heart structure, which compensates for the discharge of blood. In this case, patients complain of fainting due to compression of the coronary arteries, associated with transverse heart block. If there is only an aneurysm of the sinus of Valsalva, then the condition worsens very quickly.

Rupture can be caused by an increase in blood pressure, intense physical activity, a blow to the chest, trauma, an inflammatory process in the myocardium, or endocarditis.

Patients experience unbearable pain in the chest and abdomen (due to liver overflow), difficulty breathing, rapid heartbeat, and dizziness.

The ejection of blood from the ventricles decreases, which is accompanied by an increase in circulatory failure and pulmonary edema. With sudden overflow of the right ventricle, cardiac arrest may occur, since its myocardium is much weaker than that of the left. The pressure decreases, when listening to the heart, the noise of a “running machine” and trembling during contraction are detected.

In the period before the rupture, some patients hear a noise in systole or diastole along the edge of the sternum on the left side.

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Diagnosis of the condition

To confirm the diagnosis, an instrumental examination is performed.

ECG, EchoCG

It is impossible to draw a conclusion about the presence or absence of an aneurysm in the patient. If the right or left half is overfilled, then indirect signs of overload appear.

As with other anomalies of the heart structure, data obtained from ultrasound are used to diagnose aortic heart disease. It can be performed either transthoracically or with. In this case, the following symptoms are revealed:

dilated sinus, which protrudes into one of the chambers of the heart;
discharge of blood during diastole (with breakthrough);
reverse blood flow at the aortic valve.

X-ray and other methods

With a plain chest x-ray, you can notice an enlarged shadow of the heart, especially the right side, and an enhanced pulmonary pattern due to the overcrowded right ventricle.

To determine the exact dimensions before surgical correction, patients are prescribed aortography (visualization of the ventricles), MRI as an independent method or in conjunction with angiography.

Treatment of sinus of Valsalva aneurysm

The abnormal structure of the sinus of Valsalva can only be eliminated with surgical treatment. In this case, the following actions are provided:

Connection to a heart-lung machine.
The protrusion is stitched and cut off.
The defect site is covered with a synthetic patch from the side of the aorta or heart chamber.

An alternative technique is to retract the sac into the lumen of the aorta, then it is sutured and partially removed. The difficulty of performing the operation arises in the close proximity of the aneurysm and the coronary artery. In this case, preference is given to suturing the cavity from the side of the heart. At the same time, correction of other malformations or plastic surgery of the aortic valve can be carried out.

Prognosis for patients

The severity of this disease is due to the fact that the aneurysm does not manifest itself until the moment of rupture. And when this event occurs, surgery is indicated as soon as possible, which is difficult to implement, since neither the doctor nor the patient has any suspicion about the impending danger.

If a large defect occurs between the aorta and the heart, it causes a large shunt of blood and death due to acute heart failure.

Even with a relatively small breakthrough, patients cannot live more than 2 years with such a defect, since blood stagnation inevitably develops in the arterial and venous system, ending in cardiac arrest.

If surgery is performed in a timely manner, the chances of survival increase significantly. Such patients have a gradual return to normal activities, but they should be monitored by a cardiologist over a long period of time (at least a year).

A sinus of Valsalva aneurysm occurs due to weakness of the aortic wall at the insertion of the valve. The disease is often of congenital origin. Symptoms before rupture are absent or not specific. The aneurysm ruptures into the nearby part of the heart with the development of acute or chronic circulatory failure.

For making a diagnosis, the most informative are cardiac ultrasound and MRI. Treatment is only surgical; without it, patients are doomed.

General information

Aneurysm of the sinus of Valsalva is a rare congenital or acquired pathology, which is a sac-like or finger-like protrusion of the aortic sinuses. The most common congenital form of pathology occurs in cardiology, accounting for 0.1-3.5% of all congenital heart defects. The majority (70-80%) of patients with congenital sinus of Valsalva aneurysm are male.

Aneurysm of the sinus of Valsalva in 70% of cases is localized in the area of the right coronary sinus, in 25% in the area of the non-coronary (posterior) sinus, in 5% in the area of the left coronary sinus. The literature contains data on aneurysms of all three sinuses simultaneously. The dimensions of the aneurysmal sac can vary between 0.8-3 cm.

Each variant of the defect can occur with or without rupture of the aneurysm in the presenting parts of the heart. Congenital aneurysms of the sinus of Valsalva are often combined with ventricular septal defects (40-50%), atrial septal defect, aortic insufficiency, coarctation of the aorta, patent ductus arteriosus, and pulmonary stenosis.

Causes

It is assumed that the formation of a congenital aneurysm of the sinus of Valsalva is based on the weakness of the connection of the aortic wall with the fibrous ring, which causes detachment of the middle tunic of the aorta (media) and the formation of an aneurysm. Thus, the prerequisites for the formation of an aneurysm of the sinus of Valsalva can be laid in the embryonic period, but at the time of birth the aneurysm, as a rule, is not detected. Over the course of life, the aneurysm increases in size and its walls gradually become thinner, which ultimately leads to perforation. Rupture of an aneurysm of the sinus of Valsalva most often occurs between the ages of 20 and 40 years, but can also occur in young children.

The causes of acquired aneurysms of the sinus of Valsalva are inflammatory (tuberculosis, syphilis, infective endocarditis) and degenerative diseases (connective tissue dysplasia, atherosclerosis, cystic medial necrosis), and chest trauma. In these cases, an aneurysm of the sinus of Valsalva is caused by degeneration of the connective tissue lining the inner surface of the sinus.

Symptoms of an aneurysm

In the vast majority of cases, sinus of Valsalva aneurysms do not cause hemodynamic disturbances before rupture and are asymptomatic. Less commonly, by bulging into the right ventricle, the aneurysm obstructs the flow of blood into the trunk of the pulmonary artery. It is possible that the aneurysm may compress the conduction pathways of the heart, which is accompanied by rhythm disturbances of various types.

Severe clinical symptoms develop when an aneurysm of the sinus of Valsalva ruptures and is caused by the discharge of blood from the aorta into one or another chamber of the heart. Aneurysms arising from the right coronary sinus rupture into the right atrium or right ventricle; aneurysms of the non-coronary sinus of Valsalva - most often in the right atrium; aneurysms of the left coronary sinus - into the pulmonary artery and left ventricle.

According to the variant of the clinical course, rupture of the aneurysm of the sinus of Valsalva is distinguished with a gradual deterioration of the condition (when there is another congenital heart defect) and with a sharp deterioration of the condition (with an isolated aneurysm of the aortic sinus). The degree of hemodynamic disturbance is determined by the volume of blood discharge, which, in turn, depends on the pressure in the aorta and the diameter of the perforation.

Rupture of an aneurysm of the sinus of Valsalva can be provoked by physical activity, arterial hypertension, bacterial endocarditis, and trauma. The moment of breakthrough is accompanied by the appearance of chest pain, shortness of breath, tachycardia, arterial hypotension, and the development of heart failure. In the acute period, pulmonary edema may develop.

Characteristic objective signs are systolic-diastolic (“machine”) murmur over the heart region, diastolic hypotension, and systolic tremor. A large discharge of blood into the right side of the heart can cause acute overflow of the right ventricle, leading to the death of the patient.

Diagnostics

According to electrocardiography, specific signs of an aneurysm of the sinus of Valsalva are not detected; in case of aneurysm rupture, acute overload of the right or left parts of the heart is noted. In the preclinical stage, auscultation reveals a systolic or diastolic murmur along the left edge of the sternum. Phonocardiography reveals a high-amplitude murmur, usually occupying the entire systole and diastole.

A chest x-ray reveals an increase in the size of the heart, especially in the right parts, and an increase in the pulmonary pattern. A highly informative diagnostic method is transthoracic or transesophageal echocardiography. With the help of echocardiography, dilation of the sinus of Valsalva is detected, bulging into the corresponding cavity of the heart, even before the aneurysm ruptures. Doppler cardiography allows to detect diastolic shunting of blood during aneurysm rupture, regurgitation on the aortic valve, if any. The immediate and long-term postoperative results are satisfactory.

Forecast

The fact that aneurysm of the sinus of Valsalva in most cases remains unrecognized until the moment of rupture is a factor that aggravates the prognosis of the disease. When a large arteriovenous fistula forms between the aorta and the right side of the heart, a large discharge of blood occurs, which quite quickly leads to acute heart failure and death of the patient. In cases where the size of the resulting message is small, patients live on average 1-2 years, dying from congestive heart failure or bacterial endocarditis.

The sinus of Valsalva is commonly called a protrusion of the aortic wall in the area where the semilunar valves are located. In this place, the vessel wall is weakest, since here the muscular part of the ventricle ends, and the vascular wall does not begin yet.
Changes in the heart with this defect are manifested in the fact that an aneurysmal expansion forms in the sinus area, gradually thinning the interventricular septum or even the wall of the heart. Depending on the direction of the aneurysm, it ruptures either into the cavity of the right ventricle, or through the wall of the ventricle into the pericardial cavity. As a result of a breakthrough into the heart chamber, a large discharge of arterial blood into the venous bed occurs. Rupture of the wall of the right ventricle leads to sudden death from cardiac tamponade with blood (Fig. 109).
In addition, a breakthrough may occur in the pulmonary artery in the area of its semilunar valves.
Sometimes an aneurysm is a consequence of syphilis or endocarditis and quite rarely represents a congenital anomaly. Usually this defect does not appear until the aneurysm ruptures. Taussig (1947) reports that aneurysm rupture most often occurs between the ages of 14 and 30 years.
Congenital aneurysm of the sinus of Valsalva can be combined with other heart defects, then its clinical picture will depend on the nature of this second anomaly.
Clinic. In cases of isolated defect, the moment of aneurysm rupture is usually accompanied by severe pain in the heart area, occurring suddenly. Soon a rapidly progressing
shortness of breath and symptoms of cardiac failure develop and increase over a short period of time. Cyanosis, as a rule, does not occur; its appearance serves as a signal of blood stagnation in the systemic circulation and heart failure. The discharge of blood through a rapidly stretching hole increases quite quickly and occurs both at the moment of systole and during diastole. The consequence of this is the presence of a very loud systole-diastolic noise behind sternum, which can be easily heard and even felt upon palpation. The noise in its nature resembles the “machine-like” noise of an patent ductus arteriosus. But in this case, it is louder and sounds most sharply in the area of the manubrium of the sternum, where trembling of the chest wall is also detected.
The borders of the heart are expanded in both directions, especially to the right.
Blood pressure is usually reduced, both systolic and especially diastolic.
X-ray examination makes it possible to establish the expansion of the cavities of the heart and blood overload in the pulmonary circulation. The electrocardiogram very often reveals a complete transverse block.
In case of sudden chest pain and rapid deterioration of the condition, as well as the described clinical picture, diagnosing a ruptured aneurysm does not present any great difficulties. If the diagnosis is in doubt, then special examinations of the patient can be carried out; cardiac probing, contrast study in the form of aortography. Cardiac catheterization will indicate massive arterial shunting at the level of the right ventricle or pulmonary artery, and possibly the right atrium. Aortography may be useful if it is possible to pass a probe into the ascending aorta, to its valves. But often diagnosis is so difficult that special studies do not solve the problem.
The prognosis for sinus of Valsalva aneurysm is poor. From the moment the aneurysm ruptures, patients live very short lives. Rapidly developing heart failure is not amenable to therapeutic treatment. Surgical treatment has not been developed.

With transthoracic echocardiography, the aorta can be visualized: the root, proximal parts of the ascending part and part of the descending part behind the left atrium - from the projection along the long parasternal axis of the left ventricle, and the arch and part of the descending aorta - from the suprasternal approach. However, transesophageal echocardiography is more informative, the indication for which is a suspicion of aortic disease.

Diseases of the aorta of the heart

Normally, the aorta is defined as a hollow tubular formation emanating from the left ventricle with smooth walls up to 3 mm thick and a diameter of: from 2.0 to 3.7 cm - in the ascending section, no more than 2.4 cm - in the area of the arch and from 1.0 to 1.3 cm - in the descending section. In this case, the systolic amplitude of movement of the aortic root should be more than 7 mm.

The most common pathology is atherosclerosis, which is manifested by changes in the walls of the aorta: local or diffuse thickening and compaction, uneven contour (Fig. 8.10).

Rice. 8.10. Signs of atherosclerosis of the aorta. Image from parasternal long axis view in B- and M-mode

Based on the severity of these changes, the degree of damage to the aortic walls is determined: mild, moderate, severe.

(Fig. 8.11) complicate atherosclerotic lesions, but can also be a manifestation of other diseases, such as nonspecific aortoarteritis, Marfan syndrome, syphilitic aortitis, medianecrosis of the aorta (Erdheim disease), as well as the result of injuries or concomitant pathology with congenital anomalies, for example bicuspid aortic valve .

There are the following morphological variants of aneurysm:

fusiform- diffuse expansion of the aortic segment;
saccular - expansion of part of the circumference of the aorta in the form of a protrusion.

In addition, there are “true” aneurysms, in which the pathological expansion of the lumen affects all the membranes of the vessel wall, and “false”, which represent a rupture of the inner or middle layer of the aortic wall, resulting in an expansion of its segment, and the wall consists of outer membrane and/or perivascular clot.

Direct echocardiographic evidence of aortic aneurysm there is a significant, more than twofold, expansion of the aortic lumen. A decrease in wall pulsation is characteristic. Thrombi located near the wall may be detected.

Aortic dissection (dissection)

Aortic dissection (dissection) can also be diagnosed by transthoracic echocardiography and TEE. The sensitivity of these methods for this pathology is 80 and 94%, specificity - 95 and 98%, respectively, which is comparable to similar indicators of computed tomography - 83 and 100%.

According to the De Bakey classification, the following 3 types of aortic dissection are distinguished depending on the location of the detached intima:

type I - in the ascending aorta, arch and descending aorta;
type II - in the ascending aorta;
type III - in the descending aorta.

The main sign of aortic dissection during echocardiography is an additional contour of the vessel wall, which divides the vessel into two parts (Fig. 8.12).

When an aneurysm ruptures, a violation of the integrity of its wall is visualized with intimal detachment, defined as a linear mobile, floating formation in the aortic lumen - a defect in the aneurysm wall. In case of aortic valve insufficiency, there is a possibility of aneurysm rupture spreading to the aortic ring, sinuses of Valsalva, brachiocephalic vessels, prolapse of the detached intima into the cavity of the left ventricle.

Sometimes you can see a hematoma located near the aortic contour of positive thrombotic masses. Signs specific to aneurysm rupture are also considered to be aortic insufficiency, effusion in the pericardial cavity, and, less commonly, effusion in the pleural cavity.

When examining a dissecting aortic aneurysm, they determine not only the presence of its signs, but also the location of the onset of intimal detachment, its prevalence, and also indicate the severity of aortic regurgitation.

Aneurysm of the sinuses of Valsalva

Aneurysm of the sinuses of Valsalva, characterized by protrusion of the wall of one of the sinuses (their names correspond to the leaflets of the aortic valve - left coronary, right coronary, non-coronary) into the adjacent cardiac chamber, is usually a congenital anomaly (for example, with Marfan syndrome), caused by a weakness in the connection of the aortic wall with the fibrous annulus of the valve , although it can be recorded with aortoarteritis or supravalvular aortic stenosis.

The main morphological form of aneurysm of the sinuses of Valsalva- isolated in combination with other defects (septal defect, patent ductus arteriosus, coarctation of the aorta, bicuspid aortic valve, etc.).

Echocardiographic sign This pathology is a saccular protrusion of the sinus wall into one of the cavities of the heart: the right - into the right atrium or the outflow tract of the right ventricle, the left - into the left atrium, the non-coronary - into the right atrium or the outflow tract of the right ventricle.

When a sinus ruptures, an echocardiogram performed from a parasternal approach in a short-axis view at the level of the aorta visualizes both the interruption of the echo signal in the area of the aneurysmal sac (single or multiple), and signs of volume overload of that chamber, damage to the right coronary sinus, most rarely - left sinus.

During Dopplerography and color circulation, turbulent blood flow in the corresponding cavity is recorded.

It has been noted that in children it is possible detection of dilatation of the sinuses of Valsalva, more often non-coronary, in which the expansion of the sinus does not reach degree of aneurysm. Long-term observation of such patients indicates the possibility of the benign nature of this pathology and its spontaneous disappearance as the child grows.

Aortic dilatation

Aortic dilatation is a characteristic sign of connective tissue dysplasia and is detected in Marfan syndrome (Fig. 8.14),

Ehlers-Danlos, etc. In this case, mitral valve prolapse and additional trabeculae in the cavity of the left ventricle are simultaneously determined, less often - dilatation of the pulmonary artery trunk, etc.

In the absence of the listed syndromes, the possibility of other causes of aortic dilatation should be assessed - poststenotic dilatation, arterial hypertension, aortitis, medial necrosis. One can speak about idiopathic aortic dilatation only after a thorough examination, excluding all of the above.

Rice. 8.14. Aortic dilatation in Marfan syndrome