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Xu B, Kocyigit D, Betancor J, Tan C, Rodriguez ER, Schoenhagen P, Flamm SD, Rodriguez LL, Svensson LG, Griffin BP. Sinus of Valsalva Aneurysms: A State-of-the-Art Imaging Review. J Am Soc Echocardiogr 2020; 33:295-312. [PMID: 32143779 DOI: 10.1016/j.echo.2019.11.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 10/18/2019] [Accepted: 11/12/2019] [Indexed: 12/16/2022]
Abstract
Cardiovascular imaging has an important role in the assessment and management of aortic root and thoracic aorta ectasia and aneurysms. Sinus of Valsalva aneurysms are rare entities. Unique complications associated with sinus of Valsalva aneurysms make them different from traditional aortic root aneurysms. Established guidelines on the diagnosis and management of sinus of Valsalva aneurysms are lacking. This article reviews the applications of multimodality cardiovascular imaging (echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging) for the dedicated assessment and imaging-guided management of sinus of Valsalva aneurysms.
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Affiliation(s)
- Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Duygu Kocyigit
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Carmela Tan
- Department of Cardiovascular Anatomical Pathology, Cleveland Clinic, Cleveland, Ohio
| | - E Rene Rodriguez
- Department of Cardiovascular Anatomical Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Paul Schoenhagen
- Cardiovascular Imaging Laboratory, Imaging Institute, and Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Scott D Flamm
- Cardiovascular Imaging Laboratory, Imaging Institute, and Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - L Leonardo Rodriguez
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brian P Griffin
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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Hanna MF, Malguria N, Saboo SS, Jordan KG, Landay M, Ghoshhajra BB, Abbara S. Cross-sectional imaging of sinus of Valsalva aneurysms: lessons learned. Diagn Interv Radiol 2017; 23:339-346. [PMID: 28814376 PMCID: PMC5602357 DOI: 10.5152/dir.2017.16522] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 12/14/2016] [Accepted: 04/19/2017] [Indexed: 11/22/2022]
Abstract
Sinus of Valsalva aneurysm, dilatation of one or more of the aortic sinuses, is a rare but important aortic root defect, which can be a cause of some serious cardiac sequels. The purpose of this article is to review the etiopathogenesis, relevant anatomy, clinical manifestations, potential complications, multimodality imaging features, and management of this rare but important entity of sinus of Valsalva.
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Affiliation(s)
- Mina F. Hanna
- From the Department of Radiology, Cardiothoracic Imaging (M.F.H., N.M., S.S.S., K.G.J., M.L., S.A. ), UT Southwestern Medical Center, Dallas, TX, USA; Department of Radiology, Cardiothoracic Imaging (M.F.H.), UT Health Science Center, Houston, TX, USA; Department of Radiology, Cardiac Imaging (B.B.G.) Massachusetts General Hospital, Boston, MA, USA
| | - Nagina Malguria
- From the Department of Radiology, Cardiothoracic Imaging (M.F.H., N.M., S.S.S., K.G.J., M.L., S.A. ), UT Southwestern Medical Center, Dallas, TX, USA; Department of Radiology, Cardiothoracic Imaging (M.F.H.), UT Health Science Center, Houston, TX, USA; Department of Radiology, Cardiac Imaging (B.B.G.) Massachusetts General Hospital, Boston, MA, USA
| | - Sachin S. Saboo
- From the Department of Radiology, Cardiothoracic Imaging (M.F.H., N.M., S.S.S., K.G.J., M.L., S.A. ), UT Southwestern Medical Center, Dallas, TX, USA; Department of Radiology, Cardiothoracic Imaging (M.F.H.), UT Health Science Center, Houston, TX, USA; Department of Radiology, Cardiac Imaging (B.B.G.) Massachusetts General Hospital, Boston, MA, USA
| | - Kirk G. Jordan
- From the Department of Radiology, Cardiothoracic Imaging (M.F.H., N.M., S.S.S., K.G.J., M.L., S.A. ), UT Southwestern Medical Center, Dallas, TX, USA; Department of Radiology, Cardiothoracic Imaging (M.F.H.), UT Health Science Center, Houston, TX, USA; Department of Radiology, Cardiac Imaging (B.B.G.) Massachusetts General Hospital, Boston, MA, USA
| | - Michael Landay
- From the Department of Radiology, Cardiothoracic Imaging (M.F.H., N.M., S.S.S., K.G.J., M.L., S.A. ), UT Southwestern Medical Center, Dallas, TX, USA; Department of Radiology, Cardiothoracic Imaging (M.F.H.), UT Health Science Center, Houston, TX, USA; Department of Radiology, Cardiac Imaging (B.B.G.) Massachusetts General Hospital, Boston, MA, USA
| | - Brian B. Ghoshhajra
- From the Department of Radiology, Cardiothoracic Imaging (M.F.H., N.M., S.S.S., K.G.J., M.L., S.A. ), UT Southwestern Medical Center, Dallas, TX, USA; Department of Radiology, Cardiothoracic Imaging (M.F.H.), UT Health Science Center, Houston, TX, USA; Department of Radiology, Cardiac Imaging (B.B.G.) Massachusetts General Hospital, Boston, MA, USA
| | - Suhny Abbara
- From the Department of Radiology, Cardiothoracic Imaging (M.F.H., N.M., S.S.S., K.G.J., M.L., S.A. ), UT Southwestern Medical Center, Dallas, TX, USA; Department of Radiology, Cardiothoracic Imaging (M.F.H.), UT Health Science Center, Houston, TX, USA; Department of Radiology, Cardiac Imaging (B.B.G.) Massachusetts General Hospital, Boston, MA, USA
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Hoey ETD, Pakala V, Kassamali RH, Ganeshan A. A comparative analysis of ECG-gated steady state free precession magnetic resonance imaging versus transthoracic echocardiography for evaluation of aortic root dimensions. Quant Imaging Med Surg 2014; 4:300-6. [PMID: 25392817 DOI: 10.3978/j.issn.2223-4292.2014.10.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 10/06/2014] [Indexed: 11/14/2022]
Abstract
PURPOSE Accurate and reproducible measurement of aortic root dimensions is essential to inform clinical decision making. Transthoracic echocardiography (TTE) is the first line test for assessment of the aortic root but has potential limitations due to its limited field of view and restricted acoustic windows. Cardiac magnetic resonance imaging (MRI) is considered the "gold standard" technique for assessment of cardiac morphology and recently MRI reference ranges for aortic root dimensions have been published. The purpose of this study was to retrospectively compare aortic root measurements obtained from TTE with those derived from cardiac MRI. MATERIALS AND METHODS Sixty-eight patients (40 males, 28 females) who had undergone both cardiac MRI and TTE imaging within a 4-month interval (mean 62 days) were included. Steady-state-free precession MRI cine imaging was performed with an acquisition plane perpendicular to the aortic root and through the true cross sectional aortic valve plane. A cusp-commissure dimension from inside wall to inside wall in end-diastole was recorded and compared with standardized TTE derived Valsalva sinus measurements. Pearson correlation coefficients and a paired t-test were used for statistical analysis. RESULTS Mean aortic root dimension by TTE was 3.2±0.5 cm and MRI was 3.4±0.4 cm with a Pearson correlation coefficient of >0.7. Mean difference between TTE and MRI was 0.2±0.3 (P<0.001) with MRI producing a consistently higher measure. In four patients with a dilated aortic root by MRI the TTE measurement was within the normal reference range. In patients with a dilated aortic root (n=19) the mean difference was 0.2±0.4 cm (P<0.05) with MRI consistently producing the larger measure. In patients with a non-dilated aortic root t (n=49) the mean difference was 0.2±0.3 cm (P<0.05) with MRI consistently producing the larger measure. CONCLUSIONS There is a high level of correlation between TTE and MRI derived aortic root measurements at the Valsalva sinus level. MRI consistently measures the aortic root dimension higher than TTE which may under diagnose patients with a mildly dilated aortic root. Further investigation is required to properly integrate MRI into imaging assessment algorithms.
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Affiliation(s)
- Edward T D Hoey
- Department of Radiology, Heart of England NHS Foundation Trust, Birmingham B9 5SS, UK
| | - Vijaya Pakala
- Department of Radiology, Heart of England NHS Foundation Trust, Birmingham B9 5SS, UK
| | - Rahil H Kassamali
- Department of Radiology, Heart of England NHS Foundation Trust, Birmingham B9 5SS, UK
| | - Arul Ganeshan
- Department of Radiology, Heart of England NHS Foundation Trust, Birmingham B9 5SS, UK
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Hoey ETD, Ganeshan A. Multi-detector CT angiography of the aortic valve-Part 1: anatomy, technique and systematic approach to interpretation. Quant Imaging Med Surg 2014; 4:265-72. [PMID: 25202662 DOI: 10.3978/j.issn.2223-4292.2014.07.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 07/16/2014] [Indexed: 12/31/2022]
Abstract
The aortic valve and adjacent structures should be routinely evaluated on all thoracic cross-sectional imaging studies. Echocardiography and magnetic resonance imaging (MRI) are the main imaging techniques used for assessment of the aortic valve and related pathology but multi-detector computed tomography (MDCT) can offer valuable complimentary information in some clinical scenarios. Radiologists should be familiar with the indications, advantages and limitations of MDCT for assessment of the aortic valve. This article reviews aortic valve anatomy and relevant terminology, technical aspects of MDCT image optimisation and describes a suggested approach to interpretation.
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Affiliation(s)
- Edward T D Hoey
- Department of Radiology, Heart of England NHS Trust, Birmingham, UK
| | - Arul Ganeshan
- Department of Radiology, Heart of England NHS Trust, Birmingham, UK
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Harvey JJ, Hoey ETD, Ganeshan A. Imaging of the aortic valve with MRI and CT angiography. Clin Radiol 2013; 68:1192-205. [PMID: 24034550 DOI: 10.1016/j.crad.2013.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 06/20/2013] [Accepted: 07/15/2013] [Indexed: 12/31/2022]
Abstract
The aortic valve may be affected by a wide range of congenital and acquired diseases. Echocardiography is the main non-invasive imaging technique for assessing patho-anatomical alterations of the aortic valve and adjacent structures and in many cases is sufficient to establish a diagnosis and/or guide treatment decisions. Recent technological advances in magnetic resonance imaging (MRI) and multidetector computed tomography (MDCT) have enabled these techniques to play a complimentary role in certain clinical scenarios and as such can be useful problem-solving tools. Radiologists should be familiar with the indications, advantages, and limitations of MRI and MDCT in order to advise and direct an appropriate imaging strategy depending upon the clinical scenario. This article reviews the role of MRI and MDCT angiography for assessment of the aortic valve including relevant anatomy, scan acquisition protocols, and post-processing methods. An approach to interpretation and the key imaging features of commonly encountered aortic valvular diseases are discussed.
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Affiliation(s)
- J J Harvey
- Department of Radiology and Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Edgbaston, UK
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