Sinuses of Valsalva and the origin of the coronary arteries
The sinus of Valsalva are anatomic structures located within the right and left aortic cusps that provide blood flow from the proximal aorta to the right and left coronary arteries. Sinus of Valsalva aneurisms (SVA), or a dilatation between the tunica media and the aortic annulus, can be congenital or acquired[1]. SVA's may be multifactorial, but some sources have identified a lack of development of normal elastic tissue and abnormal development of the bulbus cordis [2]. SVA's most often occur on the right sinus of Valsalva (65-85%) and less often on the non-coronary (10-30%)and left (5%) coronary sinuses[3] Other disease processes that involve the aortic root (e.g. atherosclerotic aneurysms, syphilis, endocarditis, cystic medial necrosis, chest trauma) may also produce SVA, although this usually involves multiple sinuses.[4]
Complications
SVA's may enlarge enough to impinge on nearby structures such as the left atrium and may even rupture and lead to the shunting of blood from the coronary sinus to the right atrium or right ventricle. [5] If an SVA ruptures into the pericardial space, a medical emergency called cardiac tamponade may develop.
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^3.Wang KY, St John Sutton M, Ho HY, Ting CT. Congenital sinus of Valsalva aneurysm: a multiplane transesophageal echocardiographic experience. J Am Soc Echocardiogr. Nov-Dec 1997;10(9):956-63. [Medline].
^2.Meier JH, Seward JB, Miller FA, et al. Aneurysms in the left ventricular outflow tract: clinical presentation, causes, and echocardiographic features. J Am Soc Echocardiogr. Jul 1998;11(7):729-45. [Medline].
