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Contemporary outcomes of conservatively managed sinus of valsalva aneurysms: a 20-year Cleveland clinic experience

Session Diagnostic toolkit for a dilated aorta

Speaker Serge Harb

Event : ESC Congress 2018

  • Topic : diseases of the aorta, peripheral vascular disease, stroke
  • Sub-topic : Aortic Aneurysm, Thoracic
  • Session type : Moderated Posters

Authors : B Xu (Cleveland,US), C Rivas (Cleveland,US), J Betancor (Cleveland,US), S Harb (Cleveland,US), V Menon (Cleveland,US), B Griffin (Cleveland,US), LL Rodriguez (Cleveland,US)

B. Xu1 , C. Rivas2 , J. Betancor1 , S. Harb1 , V. Menon1 , B. Griffin1 , L.L. Rodriguez1 , 1Cleveland Clinic Foundation, Section of Cardiovascular Imaging, Heart and Vascular Institute - Cleveland - United States of America , 2Cleveland Clinic Foundation, Department of Internal Medicine - Cleveland - United States of America ,

European Heart Journal ( 2018 ) 39 ( Supplement ), 1253

Background: Sinus of Valsalva aneurysms (SVAs) are rare. The outcomes of conservatively managed SVAs are not well known.

Purpose: We assessed the contemporary outcomes of conservatively managed SVAs.

Methods: Single-center retrospective analysis over a 20-year period (January 1997 to June 2017).

Results: 103 patients with SVAs were identified: 76 patients were surgically managed (74%); 27 patients were conservatively managed (26%). The mean patient age was: 62±20 years (vs. 54±16 years in surgical group), and the majority were male (67%). The commonest co-morbidity was hypertension (67%). Most SVAs were non-ruptured at diagnosis (93% vs. 70% in the surgical group, p<0.05). The indications for conservative management were: 1. Non-surgical size/stable on serial imaging (48%); 2. Age and co-morbidities (30%); 3. Refusal of surgery (7%). The mean duration of follow-up was 4.8 years. There were no complications or deaths directly caused by SVAs. 6 patients (22%) died from non-SVA related causes: 4 died from malignancies, 2 died from gastrointestinal bleeding.

Conclusions: In a contemporary 20-year cohort, less than one third of patients with SVAs were conservatively managed. These patients were generally older, and were more likely to present with non-ruptured SVAs. At a mean follow-up of 4.8 years, 6 deaths occurred from non-SVA related causes.

Study Cohort Characteristics
Diagnostic study (n, %)
– Transthoracic echocardiography23 (85.2)
– Transesophageal echocardiography6 (22.2)
– Computed tomography10 (37.0)
– Cardiac magnetic resonance4 (14.8)
SVA size at diagnosis (cm)3.8±1.0
– Range (cm)3.1–6.7
Location of SVA (n, %)
– Right coronary sinus16 (59.3)
– Non coronary sinus10 (37.0)
– Left coronary sinus1 (3.7)
Condition of affected sinus (n, %)
– Non-ruptured25 (92.6)
– Ruptured2 (7.4)
Follow-up (years)4.8
Characteristics of the Conservatively Managed Sinus of Valsalva Aneurysms.

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