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PLoS One. 2017 Mar 14;12(3):e0173122. doi: 10.1371/journal.pone.0173122. eCollection 2017.

Echocardiographic diagnosis of rare pathological patterns of sinus of Valsalva aneurysm.

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Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology; Hubei Provincial Key Laboratory of Molecular Imaging, Wuhan, Hubei, China.
The Heart Center, St. Christopher's Hospital for Children and Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America.



To evaluate the value and improve the diagnostic accuracy of echocardiography in the diagnosis of a sinus of Valsalva aneurysm (SVA) with rare pathological patterns.


Echocardiographic features and surgical findings from 270 Chinese patients with SVA treated in the last 18 years (1995-2013) at the Union Hospital were compared retrospectively; 22 of 270 cases had rare patterns.


The patients with SVA, a rare origin, a rare extending position, or a rare course accounted for 3.4%, 7.4%, and 0.4% of the 270 cases, respectively. The three most common aneurysmal complications of the patients with rare patterns were severe aortic regurgitation (16), obstruction of the ventricular outflow tract or valvular orifice (3), and conduction disturbance (3). The origin, course, extending position and rupture status of the SVAs determined by echocardiography were entirely consistent with surgical findings in 81.8% of the 22 cases. With the exception of one failed diagnosis of an aneurysmal wall dissection and one misdiagnosis of a descending aortic dissection, the echocardiographic results of SVA complications and associated cardiovascular lesions were also confirmed.


We could accurately diagnose SVAs with rare pathological patterns by echocardiographic identification of distinguishing features. However, for several conditions, we could not accurately identify the origin or course of the aneurysm or define its relationship to adjacent structures using conventional echocardiography alone. Therefore, we recommend combining conventional echocardiography with different imaging techniques, such as transesophageal echocardiography, three-dimensional echocardiography, computed tomography angiography, and aortic angiography.

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