Rupture of the Sinus of Valsalva
Synonyms and keywords: SOVA rupture

# Overview

# Historical Perspective
 was first discovered by , a , in /during/following .
The association between  and  was made in/during .
In ,  was the first to discover the association between  and the development of .
In ,  mutations were first implicated in the pathogenesis of .
There have been several outbreaks of , including -----.
In ,  was developed by  to treat/diagnose .

# Classification
There is no established system for the classification of .
OR
 may be classified according to  into  subtypes/groups: , , , and .
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 may be classified into  subtypes based on , , and .
 may be classified into several subtypes based on , , and .
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Based on the duration of symptoms,  may be classified as either acute or chronic.
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If the staging system involves specific and characteristic findings and features:
According to the , there are  stages of  based on the , , and . Each stage is assigned a  and a  that designate the  and .
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The staging of  is based on the .
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There is no established system for the staging of .

# Pathophysiology
- Sinus of valsalva is an enlargement of the aortic root, between the aortic valve and sinotubular ridge. 
- Anatomic positioning of each sinus is a major determinant of clinical outcome.
- Non-ruptured SOVA is usually asymptomatic, however it can lead to cardiac arrhythmia such as atrial fibrillation and complete heart block.. It also can cause mild aortic regurgitation in one third of patients.
- ruptured sinus of valsalva aneurysm is a feared complication:
Rupture of the right and non-coronary sinus typically results in communication between the aorta and either right atrium or ventricle, a left to right shunt.
left sinus of valsalva rupture is clinically less significant., causing communication to the left atrium or ventricle.
- Rupture of the right and non-coronary sinus typically results in communication between the aorta and either right atrium or ventricle, a left to right shunt.
- left sinus of valsalva rupture is clinically less significant., causing communication to the left atrium or ventricle.

# Causes
- Sinus of valsalva aneurysm can be both congenital and acquired:
Emberiologically sinus of valsalva aneurysm forms first as a blind diverticulum. the congenital form has been linked to connective tissue diseases: 
Marfan's syndrome
Ehlers-Danlos syndrome
Bicuspid aortic valves
Acquired forms of sinus of valsalva aneurysm is also seen with connective tissue diseases:
Infections that weaken elastic tissue:
Syphilis
Bacterial endocarditis
Tuberculosis
Atherosclerosis and medial cystic necrosis
Chest trauma
Iatrogenic injury during aortic valve surgery
vasculitis (Takayasu's arteritis)
- Emberiologically sinus of valsalva aneurysm forms first as a blind diverticulum. the congenital form has been linked to connective tissue diseases: 
Marfan's syndrome
Ehlers-Danlos syndrome
Bicuspid aortic valves
- Marfan's syndrome
- Ehlers-Danlos syndrome
- Bicuspid aortic valves
- Acquired forms of sinus of valsalva aneurysm is also seen with connective tissue diseases:
Infections that weaken elastic tissue:
Syphilis
Bacterial endocarditis
Tuberculosis
Atherosclerosis and medial cystic necrosis
Chest trauma
Iatrogenic injury during aortic valve surgery
vasculitis (Takayasu's arteritis)
- Infections that weaken elastic tissue:
Syphilis
Bacterial endocarditis
Tuberculosis
- Syphilis
- Bacterial endocarditis
- Tuberculosis
- Atherosclerosis and medial cystic necrosis
- Chest trauma
- Iatrogenic injury during aortic valve surgery
- vasculitis (Takayasu's arteritis)

# Differentiating ((Page name)) from other Diseases
 must be differentiated from other diseases that cause , , and , such as , , and .
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 must be differentiated from , , and .

# Epidemiology and Demographics
- Sinus of valsalva aneurysm  is found in approximately 9 people out of 10000 in general populatin.
- Sinus of valsalva comprise 3.5% of all congenital heart defects.
- sinus of valsalva affects males four times more likely than females.
- higher rates are reported among Asian groups.

# Risk Factors
There are no established risk factors for .
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The most potent risk factor in the development of  is . Other risk factors include , , and .
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Common risk factors in the development of  include , , , and .
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Common risk factors in the development of  may be occupational, environmental, genetic, and viral.

# Screening
There is insufficient evidence to recommend routine screening for .
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According to the , screening for  is not recommended.
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According to the , screening for  by  is recommended every  among patients with , , and .

# Natural History, Complications, and Prognosis
- Sinus of valsalva can be completely asymptomatic.
- It can present with non-spesific complaints such as:
Dyspnea
Chest pain
Palpitation
Loss of consciousness
- Dyspnea
- Chest pain
- Palpitation
- Loss of consciousness
- Classic physical findings are not present until rupture of n sinus of valsalva.
- When not ruptured, They may present with a diastolic descrescendo murmur suggestive of aortic regurgitation., while in ruptured cases there will be a continuous murmur and decreased exercise tolerence and in advanced phase, even congestive heart failure.

# Diagnosis

## Diagnostic Study of Choice
The diagnosis of  is made when at least  of the following  diagnostic criteria are met: , , , and .
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The diagnosis of  is based on the  criteria, which include , , and .
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The diagnosis of  is based on the  definition, which includes , , and .
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There are no established criteria for the diagnosis of .

## History and Symptoms
The majority of patients with  are asymptomatic.
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The hallmark of  is . A positive history of  and  is suggestive of . The most common symptoms of  include , , and . Common symptoms of  include , , and . Less common symptoms of  include , , and .

## Physical Examination
Patients with  usually appear . Physical examination of patients with  is usually remarkable for , , and .
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Common physical examination findings of  include , , and .
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The presence of  on physical examination is diagnostic of .
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The presence of  on physical examination is highly suggestive of .

## Laboratory Findings
An elevated/reduced concentration of serum/blood/urinary/CSF/other  is diagnostic of .
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Laboratory findings consistent with the diagnosis of  include , , and .
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 is usually normal among patients with .
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Some patients with  may have elevated/reduced concentration of , which is usually suggestive of .
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There are no diagnostic laboratory findings associated with .

## Electrocardiogram
There are no ECG findings associated with .
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An ECG may be helpful in the diagnosis of . Findings on an ECG suggestive of/diagnostic of  include , , and .

## X-ray
There are no x-ray findings associated with .
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An x-ray may be helpful in the diagnosis of . Findings on an x-ray suggestive of/diagnostic of  include , , and .
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There are no x-ray findings associated with . However, an x-ray may be helpful in the diagnosis of complications of , which include , , and .

## Echocardiography or Ultrasound
There are no echocardiography/ultrasound  findings associated with .
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Echocardiography/ultrasound  may be helpful in the diagnosis of . Findings on an echocardiography/ultrasound suggestive of/diagnostic of  include , , and .
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There are no echocardiography/ultrasound  findings associated with . However, an echocardiography/ultrasound  may be helpful in the diagnosis of complications of , which include , , and .

## CT scan
There are no CT scan findings associated with .
OR
 CT scan may be helpful in the diagnosis of . Findings on CT scan suggestive of/diagnostic of  include , , and .
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There are no CT scan findings associated with . However, a CT scan may be helpful in the diagnosis of complications of , which include , , and .

## MRI
There are no MRI findings associated with .
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 MRI may be helpful in the diagnosis of . Findings on MRI suggestive of/diagnostic of  include , , and .
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There are no MRI findings associated with . However, a MRI may be helpful in the diagnosis of complications of , which include , , and .

## Other Imaging Findings
There are no other imaging findings associated with .
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 may be helpful in the diagnosis of . Findings on an  suggestive of/diagnostic of  include , , and .

## Other Diagnostic Studies
There are no other diagnostic studies associated with .
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 may be helpful in the diagnosis of . Findings suggestive of/diagnostic of  include , , and .
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Other diagnostic studies for  include , which demonstrates , , and , and , which demonstrates , , and .

# Treatment

## Medical Therapy
There is no medical treatment for rupture of sinus of valsalva; the mainstay of therapy is surgical management.

## Surgery
Surgery is not the first-line treatment option for patients with ruptured sinus of valsalva.
- Non ruptured sinus of valsalva aneurysm should be surgically repaired if :
It is assosiated with significant symptome
It is rapidly enlarging
- It is assosiated with significant symptome
- It is rapidly enlarging

## Primary Prevention
There are no established measures for the primary prevention of .
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There are no available vaccines against .
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Effective measures for the primary prevention of  include , , and .
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 vaccine is recommended for  to prevent . Other primary prevention strategies include , , and .

## Secondary Prevention
There are no established measures for the secondary prevention of .
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Effective measures for the secondary prevention of  include , , and .