Diagnosis and treatment options for sinus of Valsalva aneurysms: A narrative review

Table 1 Comparison table of noninvasive imaging modalities used in the diagnosis and assessment of sinus of Valsalva aneurysms

Imaging modalities	General information	Strengths	Limitations
TTE	The first imaging modality of choice for diagnosis of SoVA	Possess > 90% accuracy for detecting SoVA. It is additionally safe, cost-effective, portable, and more widely available	Can sometimes incorrectly detect rupture site
TEE	Required as additional imaging in up to 25% of cases to further characterize the anatomy of the sinuses and their surrounding structures	Possesses better acoustic window and higher resolution, which facilitates more accurate characterization of the aneurysm and its surrounding structures	Contraindicated in patients with esophageal disease including known stricture, varices, diverticula, or tumors
ECG-gated MDCT	An acquisition technique that triggers a scan during a particular portion of the cardiac cycle	Provides high spatial resolution, elimination of motion artifacts, and improved temporal resolution in the nonemergent setting. Additionally, gated CT’s ability to obtain multiplanar reformations provides superior anatomic delineation and can simultaneously assess the coronary arteries	More cost prohibitive. Additionally, retrospective ECG gating is needed to assess ventricular function and valvular motion, which carries a high radiation burden
Cardiac MRI	Plays an important role in SoVA assessment and is particularly important in the assessment of biventricular function	Gold standard imaging technique for SoVA due to its lack of ionizing radiation, better temporal resolution, ability to quantify ventricular function and aortic regurgitant fraction, and provides an assessment of wall motion abnormalities	More cost prohibitive

TTE: Transthoracic echocardiogram; SoVA: Sinus of Valsalva aneurysm; TEE: Transesophageal echocardiogram; ECG-gated MDCT: Electrocardiographic-gated multi detector computed tomography; CT: Computed tomography; ECG: Electrocardiogram; MRI: Magnetic resonance imaging.