Angiographic features of ruptured sinus of Valsalva aneurysm: new classification.

Background: The formal classification system for ruptured sinus of Valsalva aneurysm (RSVA) is from a surgical aspect and is seldom utilized for percutaneous closure. This study was undertaken to introduce a new classification for RSVA according to the angiographic features of patients.

Methods: We retrospectively studied 30 cases of RSVA undergoing percutaneous closure between July 2005 and September 2013. The data of patients' angiographic features, management, and outcomes were collected and analyzed.

Results: The patients included 18 males and 12 females with a median age of 42.5 years (range, 24-74 years). According to the shape of left to right shunt jet, patients were divided into four types: type I, window-like, 56.7% (n=17); type II, aneurysmal, 16.7% (n=5); type III, tubular, 16.7% (n=5); and type IV, other rare conditions, 10.0% (n=3). One patient in type IV had a giant RSVA and the other 2 in type IV presented with angiographic features of long and funnel shape. Total occlusion rate was 93.3% (28 out of 30 patients) at discharge and during a median follow-up of 18.5 months (1-96 months). In patients with types I and II, small-waist double-disk ventricular septal defect (VSD) occluders were selected. In patients with type III, muscular VSD occluders were chosen. We failed in 2 out of 3 patients in type IV for serious hemolysis and occluders were retrieved finally. The proportion of patients in New York Heart Association class III/IV was reduced from 73.3% at baseline to 10% at the time of last follow-up (p<0.001).

Conclusion: According to the shape of left to right shunt jet, we propose a new and simple classification for RSVA. It could help toward the better understanding of angiographic morphology of RSVA and facilitate the selection of occluders for percutaneous closure.