title: 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.
abstract: OBJECTIVE
  To evaluate the value of echocardiography in the diagnosis of different pathological patterns of sinus of Valsalva aneurysms (SVAs).
  
  
  METHODS
  Echocardiographic features and surgical findings of 212 consecutive patients with SVAs treated in the last 17 years (1995-2012) at the Union Hospital of Huazhong University of Science and Technology were compared and analyzed retrospectively.
  
  
  RESULTS
  212 Chinese patients with SVAs underwent surgical repairs from January 1995 to May 2012 in our hospital. The aneurysms originated from the right, non-, multiple and left coronary sinus in 77.8%, 19.3%, 2.4% and 0.5%, respectively. 71.7% were ruptured, most commonly into the right ventricle (67.9%) followed by the right atrium (27.4%). Other rare entry sites of rupture included the left atrium, the left ventricle, the interatrial septum, the interventricular septum and the pulmonary artery (0.5%-1.9%). 164 SVAs arising from the right coronary sinus were classified by the Sakakibara method: 47.6% type I, 33.5% type II, 6.1% type IIIv and 12.8% type IIIa. 41 aneurysms of the non-coronary sinus were classified by the Guo method: 61.0% type I, 34.1% type IIa and 4.9% type IIv. The three most common associated cardiovascular lesions were ventricular septal defect (VSD) (53.3%), stenosis of right ventricular outflow tract (RVOTS) (7.5%) and aortic valvular malformations (5.2%). Compared with surgical results, the sensitivity, specificity and accuracy of echocardiographic diagnosis of SVAs were 93.9%, 99.9% and 99.8%, respectively. Of the 13 SVAs that were missed on echocardiography, 77% were small aneurysms of the right coronary sinus extending into the right ventricle across a VSD. Of the 199 cases diagnosed by echocardiography prior to surgery, the diagnostic accuracy of aneurismal origination, termination and whether ruptured or not was 99.0%, 99.0% and 97.5%, respectively. Echocardiography also diagnosed accurately all of the complications of the SVAs with the exception of aneurismal vegetations. The sensitivity, specificity and accuracy of echocardiography in diagnosing the associated cardiovascular lesions were 89.2%, 99.9% and 99.0%, respectively. The most common misdiagnosis and misdiagnosed associated lesions were the RVOTS and the types of VSD, respectively.
  
  
  CONCLUSIONS
  Echocardiography has a specific value in the diagnosis of different pathological patterns of the SVAs with distinguishing ultrasonic features. To the best of our knowledge, this is the largest series of patients with SVAs surgically treated in a single medical center.
authors.affiliation: Department of Ultrasonography, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Provincial Key Laboratory of Molecular Imaging, Wuhan 430022, China; Department of Medicine, The George Washington University Medical Center, 2150 Pennsylvania Avenue, N.W., Washington, DC, USA. Electronic address: tcheng@mfa.gwu.edu.
authors.forename: Tsung O
authors.initials: TO
authors.lastname: Cheng
authors.affiliation: Department of Ultrasonography, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Provincial Key Laboratory of Molecular Imaging, Wuhan 430022, China.
authors.forename: Ya-Li
authors.initials: YL
authors.lastname: Yang
authors.affiliation: Department of Ultrasonography, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Provincial Key Laboratory of Molecular Imaging, Wuhan 430022, China.
authors.forename: Ming-Xing
authors.initials: MX
authors.lastname: Xie
authors.affiliation: Department of Ultrasonography, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Provincial Key Laboratory of Molecular Imaging, Wuhan 430022, China.
authors.forename: Xin-Fang
authors.initials: XF
authors.lastname: Wang
authors.affiliation: Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Provincial Key Laboratory of Molecular Imaging, Wuhan 430022, China.
authors.forename: Nian-Guo
authors.initials: NG
authors.lastname: Dong
authors.affiliation: Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Provincial Key Laboratory of Molecular Imaging, Wuhan 430022, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Su
authors.affiliation: Department of Ultrasonography, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Provincial Key Laboratory of Molecular Imaging, Wuhan 430022, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Lü
authors.affiliation: Department of Ultrasonography, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Provincial Key Laboratory of Molecular Imaging, Wuhan 430022, China.
authors.forename: Lin
authors.initials: L
authors.lastname: He
authors.affiliation: Department of Ultrasonography, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Provincial Key Laboratory of Molecular Imaging, Wuhan 430022, China.
authors.forename: Xiao-Fang
authors.initials: XF
authors.lastname: Lu
authors.affiliation: Department of Ultrasonography, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Provincial Key Laboratory of Molecular Imaging, Wuhan 430022, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Ultrasonography, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Provincial Key Laboratory of Molecular Imaging, Wuhan 430022, China.
authors.forename: Ling
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Ultrasonography, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Provincial Key Laboratory of Molecular Imaging, Wuhan 430022, China.
authors.forename: Li
authors.initials: L
authors.lastname: Yuan
mesh_terms: D000293:Adolescent; D000328:Adult; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery; D001019:Aortic Rupture / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D004452:Echocardiography / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012850:Sinus of Valsalva / Q000000981:diagnostic imaging* / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Echocardiographic diagnosis; Sinus of Valsalva aneurysm; Surgical treatment