Patch Repair of Double Sinus of Valsalva Aneurysms

Patch Repair of Double Sinus of Valsalva Aneurysms | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Patch Repair of Double Sinus of Valsalva Aneurysms Blake Lyon, Lisa Soler, Sasha Still This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7171538/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 16 You are reading this latest preprint version Abstract Background Sinus of Valsalva aneurysm (SoVA) is a rare, acquired or congenital heart anomaly in which one or more of the aortic sinuses become abnormally dilated. SoVAs are commonly asymptomatic and found incidentally on cardiac imaging studies. Unruptured SoVA may be associated with various forms of arrhythmia, angina, or exertional dyspnea. Symptom severity and type depend on the size and location of SoVA, as well as the degree of concomitant aortic regurgitation. Less frequently, SoVA may rupture and lead to heart failure and even cardiovascular collapse. Case presentation We report a case of a 76-year-old male incidentally diagnosed with two large, unruptured saccular sinus of Valsalva aneurysms, involving the left and right coronary sinuses, who underwent successful patch repair. Conclusion SoVAs are rare cardiac abnormalities which, when large or multiple, have an elevated risk of rupture leading to hemodynamic compromise and death. Timely surgical management should be prioritized in unique cases of large, numerous SoVAs. Sinus of Valsalva aneurysm unruptured patch repair SoVA Figures Figure 1 Figure 2 Figure 3 BACKGROUND A sinus of Valsalva aneurysm (SoVA) is a rare condition in which one or more aortic sinuses become abnormally dilated. The prevalence of SoVAs is estimated to be around 0.1% in the general population but appears to be more common in men and people of Asian descent [1,2]. SoVAs are most commonly present as a singular aneurysm in the right coronary sinus and generally do not cause symptoms if unruptured but can quickly become lethal if ruptured due to hemodynamic compromise. As such, unruptured SoVAs should be evaluated by a cardiovascular surgeon to determine appropriate treatment. There are no specific guidelines regarding how unruptured SoVAs should be managed; however, surgical treatment has been preferred to avoid lethal complications of rupture and is associated with favorable outcomes [3,4].The determination of the surgical technique used to treat the SoVAs primarily depends on the size, location, and number of SoVAs, involvement of the aortic valve, or the presence of intracardiac or extracardiac rupture [1,2]. We present a case of double SoVAs involving the left and right coronary sinuses successfully managed through patch repair of both aneurysms. CASE PRESENTATION A 76-year-old asymptomatic male with a past medical history significant for type 2 diabetes mellitus, obesity (BMI 37.23 kg/m 2 ), chronic systolic heart failure, hyperlipidemia, alcohol abuse, tobacco abuse, and coronary artery disease underwent computed tomography of the chest after an abnormal hypolucency was seen on chest x-ray. Imaging, as shown in Figure 1 and Figure 2, demonstrated the presence of two large, unruptured saccular SoVAs. The SoVA of the right sinus was 40 mm at maximum diameter and inferior to the right coronary artery; it extended into the right ventricular outflow tract. The SoVA of the left sinus measuring 41 mm originated anterior to the left coronary artery ostium and extended into the pericardium below the main pulmonary artery. Further workup included a transthoracic echocardiogram showing a left ventricular ejection fraction of 45-50% and normal pulmonary function tests. A pre-operative left heart catheterization revealed coronary ectasia with mild non-obstructive coronary artery disease. The patient was electively taken to the operating room, where he underwent repair. His preoperative transesophageal echo noted a dilated aortic root with aneurysms at the left and right sinus of Valsalva, mild aortic insufficiency. We approached this through median sternotomy with standard aortic and right atrial cannulation. He was given antegrade and retrograde cardioplegia to maintain arrest and kept normothermic at 37 degrees. The root was accessed through transverse aortotomy and noted to be 4.5 cm and indexed to low risk for his size. We opted for patch repair using 1.5x oversized Dacron patch for each sinus. Using 4-0 prolene in a running fashion, the Dacron patch was placed to each sinus. Following the patch repair, the valve leaflets were extensively evaluated and were found to be fully competent and uninjured, requiring no further intervention. The aortotomy was closed, and the patient was successfully separated from bypass and closed in standard fashion. Postoperative transesophageal echo noted preserved function with improvement in aortic insufficiency to trace. He was extubated the day of surgery and was discharged home four days later following an uneventful postoperative course. At one month follow up in clinic patient was noted to be recovering well and had CT chest, as shown in Figure 3(A,B), with stable post-operative findings and satisfactory repair. DISCUSSION AND CONCLUSIONS SoVAs are extremely rare cardiac abnormalities that have been identified in 0.15-1.5% of patients undergoing heart surgery, most of which are observed during congenital heart surgery. Even more rare are acquired SoVAs, which can be caused by infected endocarditis, connective tissue diseases, degenerative diseases, or trauma [5]. They are commonly small and asymptomatic; however, large SoVAs are more likely to be symptomatic due to mass effect on nearby structures. Large SoVAs also have a much higher risk of rupturing, leading to hemodynamic compromise and significantly increasing mortality [3,4]. The danger of a ruptured SoVA makes it imperative that SoVAs are identified early and treated appropriately. Even though urgent evaluation and treatment are needed to prevent aneurysm rupture, there are no clear guidelines on managing unruptured SoVAs. In a literature review by Nguyen et al, it was concluded that outcomes were generally more favorable when surgery was performed for unruptured SoVAs[4]. Surgical management of unruptured SoVAs prevents aneurysm growth and associated complications, such as local mass effect, aortic insufficiency, and rupture leading to hemodynamic instability, cardiac tamponade, or death [2]. SoVAs commonly involve the right coronary sinus (77-89%), less commonly the noncoronary coronary sinus (23%), and rarely the left coronary sinus (1-2%) [6]. The relative commonality of right and noncoronary sinus involvement is thought to be due to embryologic development as well as the increased wall stress that these sinuses face in comparison to the left coronary sinus [1]. As in our case, SoVAs involving multiple coronary sinuses, especially the left coronary sinus, are very rare with only 3 prior published reports [3,5,6]. The indications for surgical repair in this case included the large size and multifocality of the SoVAs, thereby doubling the risk of related complications. Patch repair is the preferred surgical method for large SoVAs if the aortic root and valve are not involved, since direct closure may distort the anatomy of the aortic root [4]. Patch repair alone was performed as the aortic root and valve were not involved, but more extensive procedures would have been considered if the aortic root or valve had been involved or if the native aortic tissue was able to hold suture. This approach shows that even with complex pathology, patch repair of double SoVA alone is an effective and durable treatment. Abbreviations SoVA Sinus of Valsalva aneurysm Declarations Ethics approval and consent to participate Not applicable Consent for publication The patient in this study provided written informed consent prior to participation. Availability of data and materials Not applicable Competing interests The authors declare that they have no competing interests. Funding Not applicable Authors’ contributions BL reviewed the literature and drafted the article. LS revised the article and assisted with drafting the operative portion of the article. SS revised the article critically for intellectual content and provided final approval of the version of the article to be published. All authors read and approved the final manuscript. Acknowledgements Not applicable References Arcario MJ, Lou S, Taylor P, Gregory SH. Sinus of Valsalva Aneurysms: A Review with Perioperative Considerations. J Cardiothorac Vasc Anesth. 2021;35(11):3340–9. 10.1053/j.jvca.2020.12.016 . Bass D, Sharma S, Tivakaran VS. Sinus of Valsalva Aneurysm. In: StatPearls . Treasure Island (FL): StatPearls Publishing; August 11, 2024. https://www.ncbi.nlm.nih.gov/books/NBK448198 . Accessed 20 May 2025. Rojo M, Kwon OJ, Olshansky B, Kieso H, Schwartz J. Repair of Giant Sinus of Valsalva Aneurysms. Annals Thorac Surg Short Rep. 2023;1(1):22–3. https://doi.org/10.1016/j.atssr.2022.11.017 . Nguyen Q, Vervoort D, Phan K, Luc JGY. Surgical management for unruptured sinus of Valsalva aneurysms: a narrative review of the literature. J Thorac Dis. 2021;13(3):1833–50. https://doi.org/10.21037/jtd-20-2682 . Ohno N, Watanabe K, Maeda T, et al. A rare case of unruptured extracardiac multiple sinus of Valsalva aneurysms originating from the orifices with partial aortic wall defects. surg case rep. 2019;5:47. https://doi.org/10.1186/s40792-019-0608-7 . Deepti S, Singh S, Jagia P, Bahl VK. Multiple sinus of Valsalva aneurysms: A ‘triple whammy’ of troubles. IHJ Cardiovasc Case Rep (CVCR). 2018;2:S136–40. 10.1016/j.ihjccr.2018.08.007 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 19 Nov, 2025 Reviews received at journal 27 Aug, 2025 Reviews received at journal 24 Aug, 2025 Reviews received at journal 23 Aug, 2025 Reviews received at journal 20 Aug, 2025 Reviewers agreed at journal 18 Aug, 2025 Reviewers agreed at journal 15 Aug, 2025 Reviewers agreed at journal 15 Aug, 2025 Reviews received at journal 15 Aug, 2025 Reviewers agreed at journal 15 Aug, 2025 Reviewers agreed at journal 15 Aug, 2025 Reviewers agreed at journal 15 Aug, 2025 Reviewers invited by journal 15 Aug, 2025 Editor assigned by journal 22 Jul, 2025 Submission checks completed at journal 22 Jul, 2025 First submitted to journal 20 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7171538","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":504658855,"identity":"f9a11d58-a9a4-40aa-8f58-33ea35c7a36c","order_by":0,"name":"Blake Lyon","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAq0lEQVRIiWNgGAWjYBACPiBmZvhhA+WyEaEFpIaZsSeNVC0MbIdJ0SKRfOxxAc/5xO1ihx8wfCg7TIyWtHTjGRa3E3fOTjNgnHGOKC05ZtI8PLcTN9zOYWDmbSNaC9s5iJa/JGg5ANHCSJQWnmdp0jN7ko1BfjnYcy6dsBZ+9uRj0gU/7GS3Syc/fPCjzJqwFgaBBAhtAMQHiFAPsuYAQssoGAWjYBSMAqwAAAcPNbsJ2LaCAAAAAElFTkSuQmCC","orcid":"","institution":"University of Alabama at Birmingham","correspondingAuthor":true,"prefix":"","firstName":"Blake","middleName":"","lastName":"Lyon","suffix":""},{"id":504658856,"identity":"fe68089d-4498-4218-9d8f-7f25c5ad3c8e","order_by":1,"name":"Lisa Soler","email":"","orcid":"","institution":"University of Alabama at Birmingham","correspondingAuthor":false,"prefix":"","firstName":"Lisa","middleName":"","lastName":"Soler","suffix":""},{"id":504658857,"identity":"c6339d8d-c0c9-42a2-8421-8a65f82b2a1c","order_by":2,"name":"Sasha Still","email":"","orcid":"","institution":"University of Alabama at Birmingham","correspondingAuthor":false,"prefix":"","firstName":"Sasha","middleName":"","lastName":"Still","suffix":""}],"badges":[],"createdAt":"2025-07-20 19:38:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7171538/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7171538/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89973418,"identity":"625c95c9-cb41-4fb0-97cf-23ac5b740bdf","added_by":"auto","created_at":"2025-08-27 05:49:41","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":61041,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePre-operative CT imaging of the left sinus of Valsalva aneurysm, measuring 41 mm, originating anterior to the left coronary artery ostium and extending into the pericardium below the main pulmonary artery.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7171538/v1/e3803adacda61e9a4b15f30c.jpg"},{"id":89975505,"identity":"951bfa14-d74b-4189-bfb8-ea7d6ba26662","added_by":"auto","created_at":"2025-08-27 05:57:42","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":116438,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePre-operative CT imaging of right sinus of Valsalva aneurysm, measuring 40 mm, noted just inferior to the right coronary artery and extending into the right ventricular outflow tract.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Picture2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7171538/v1/da3e9a27b79790d3703220ff.jpg"},{"id":89973420,"identity":"3921fe6e-2bd3-4b41-b463-240d51e92450","added_by":"auto","created_at":"2025-08-27 05:49:41","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":241948,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCoronal (A) and axial (B) views of post-operative CT chest showing stable and satisfactory repair of left and right sinus of Valsalva aneurysms.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Picture3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7171538/v1/1f51c3d091bea91cd98aaa6e.jpg"},{"id":89976779,"identity":"8517ca9a-01a3-42b6-8192-764c6f48a302","added_by":"auto","created_at":"2025-08-27 06:05:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":926174,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7171538/v1/4d03a9e4-670e-472e-b91d-b3e5f343b7a0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Patch Repair of Double Sinus of Valsalva Aneurysms","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eA sinus of Valsalva aneurysm (SoVA) is a rare condition in which one or more aortic sinuses become abnormally dilated. The prevalence of SoVAs is estimated to be around 0.1% in the general population but appears to be more common in men and people of Asian descent [1,2]. SoVAs are most commonly present as a singular aneurysm in the right coronary sinus and generally do not cause symptoms if unruptured but can quickly become lethal if ruptured due to hemodynamic compromise. As such, unruptured SoVAs should be evaluated by a cardiovascular surgeon to determine appropriate treatment. There are no specific guidelines regarding how unruptured SoVAs should be managed; however, surgical treatment has been preferred to avoid lethal complications of rupture and is associated with favorable outcomes [3,4].The determination of the surgical technique used to treat the SoVAs primarily depends on the size, location, and number of SoVAs, involvement of the aortic valve, or the presence of intracardiac or extracardiac rupture [1,2]. We present a case of double SoVAs involving the left and right coronary sinuses successfully managed through patch repair of both aneurysms.\u003c/p\u003e"},{"header":"CASE PRESENTATION","content":"\u003cp\u003eA 76-year-old asymptomatic male with a past medical history significant for type 2 diabetes mellitus, obesity (BMI 37.23 kg/m\u003csup\u003e2\u003c/sup\u003e), chronic systolic heart failure, hyperlipidemia, alcohol abuse, tobacco abuse, and coronary artery disease underwent computed tomography of the chest after an abnormal hypolucency was seen on chest x-ray. Imaging, as shown in Figure 1 and Figure 2, demonstrated the presence of two large, unruptured saccular SoVAs. The SoVA of the right sinus was 40 mm at maximum diameter and inferior to the right coronary artery; it extended into the right ventricular outflow tract. The SoVA of the left sinus measuring 41 mm originated anterior to the left coronary artery ostium and extended into the pericardium below the main pulmonary artery. Further workup included a transthoracic echocardiogram showing a left ventricular ejection fraction of 45-50% and normal pulmonary function tests. A pre-operative left heart catheterization revealed coronary ectasia with mild non-obstructive coronary artery disease.\u003c/p\u003e\n\u003cp\u003eThe patient was electively taken to the operating room, where he underwent repair. His preoperative transesophageal echo noted a dilated aortic root with aneurysms at the left and right sinus of Valsalva, mild aortic insufficiency. We approached this through median sternotomy with standard aortic and right atrial cannulation. He was given antegrade and retrograde cardioplegia to maintain arrest and kept normothermic at 37 degrees. The root was accessed through transverse aortotomy and noted to be 4.5 cm and indexed to low risk for his size. \u0026nbsp;We opted for patch repair using 1.5x oversized Dacron patch for each sinus. Using 4-0 prolene in a running fashion, the Dacron patch was placed to each sinus. Following the patch repair, the valve leaflets were extensively evaluated and were found to be fully competent and uninjured, requiring no further intervention. The aortotomy was closed, and the patient was successfully separated from bypass and closed in standard fashion. Postoperative transesophageal echo noted preserved function with improvement in aortic insufficiency to trace. He was extubated the day of surgery and was discharged home four days later following an uneventful postoperative course. At one month follow up in clinic patient was noted to be recovering well and had CT chest, as shown in Figure 3(A,B), with stable post-operative findings and satisfactory repair.\u0026nbsp;\u003c/p\u003e"},{"header":"DISCUSSION AND CONCLUSIONS","content":"\u003cp\u003eSoVAs are extremely rare cardiac abnormalities that have been identified in 0.15-1.5% of patients undergoing heart surgery, most of which are observed during congenital heart surgery. Even more rare are acquired SoVAs, which can be caused by infected endocarditis, connective tissue diseases, degenerative diseases, or trauma [5]. They are commonly small and asymptomatic; however, large SoVAs are more likely to be symptomatic due to mass effect on nearby structures. Large SoVAs also have a much higher risk of rupturing, leading to hemodynamic compromise and significantly increasing mortality [3,4]. The danger of a ruptured SoVA makes it imperative that SoVAs are identified early and treated appropriately. Even though urgent evaluation and treatment are needed to prevent aneurysm rupture, there are no clear guidelines on managing unruptured SoVAs. In a literature review by Nguyen et al, it was concluded that outcomes were generally more favorable when surgery was performed for unruptured SoVAs[4]. Surgical management of unruptured SoVAs prevents aneurysm growth and associated complications, such as local mass effect, aortic insufficiency, and rupture leading to hemodynamic instability, cardiac tamponade, or death [2].\u003c/p\u003e\n\u003cp\u003eSoVAs commonly involve the right coronary sinus (77-89%), less commonly the noncoronary coronary sinus (23%), and rarely the left coronary sinus (1-2%) [6]. The relative commonality of right and noncoronary sinus involvement is thought to be due to embryologic development as well as the increased wall stress that these sinuses face in comparison to the left coronary sinus [1]. As in our case, SoVAs involving multiple coronary sinuses, especially the left coronary sinus, are very rare with only 3 prior published reports [3,5,6]. The indications for surgical repair in this case included the large size and multifocality of the SoVAs, thereby doubling the risk of related complications. Patch repair is the preferred surgical method for large SoVAs if the aortic root and valve are not involved, since direct closure may distort the anatomy of the aortic root [4]. Patch repair alone was performed as the aortic root and valve were not involved, but more extensive procedures would have been considered if the aortic root or valve had been involved or if the native aortic tissue was able to hold suture. This approach shows that even with complex pathology, patch repair of double SoVA alone is an effective and durable treatment.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSoVA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eSinus of Valsalva aneurysm\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patient in this study provided written informed consent prior to participation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBL reviewed the literature and drafted the article. LS revised the article and assisted with drafting the operative portion of the article. SS revised the article critically for intellectual content and provided final approval of the version of the article to be published. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eArcario MJ, Lou S, Taylor P, Gregory SH. Sinus of Valsalva Aneurysms: A Review with Perioperative Considerations. J Cardiothorac Vasc Anesth. 2021;35(11):3340\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1053/j.jvca.2020.12.016\u003c/span\u003e\u003cspan address=\"10.1053/j.jvca.2020.12.016\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBass D, Sharma S, Tivakaran VS. Sinus of Valsalva Aneurysm. In: \u003cem\u003eStatPearls\u003c/em\u003e. Treasure Island (FL): StatPearls Publishing; August 11, 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/books/NBK448198\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/books/NBK448198\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 20 May 2025.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRojo M, Kwon OJ, Olshansky B, Kieso H, Schwartz J. Repair of Giant Sinus of Valsalva Aneurysms. Annals Thorac Surg Short Rep. 2023;1(1):22\u0026ndash;3. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.atssr.2022.11.017\u003c/span\u003e\u003cspan address=\"10.1016/j.atssr.2022.11.017\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNguyen Q, Vervoort D, Phan K, Luc JGY. Surgical management for unruptured sinus of Valsalva aneurysms: a narrative review of the literature. J Thorac Dis. 2021;13(3):1833\u0026ndash;50. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.21037/jtd-20-2682\u003c/span\u003e\u003cspan address=\"10.21037/jtd-20-2682\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOhno N, Watanabe K, Maeda T, et al. A rare case of unruptured extracardiac multiple sinus of Valsalva aneurysms originating from the orifices with partial aortic wall defects. surg case rep. 2019;5:47. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s40792-019-0608-7\u003c/span\u003e\u003cspan address=\"10.1186/s40792-019-0608-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDeepti S, Singh S, Jagia P, Bahl VK. Multiple sinus of Valsalva aneurysms: A \u0026lsquo;triple whammy\u0026rsquo; of troubles. IHJ Cardiovasc Case Rep (CVCR). 2018;2:S136\u0026ndash;40. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ihjccr.2018.08.007\u003c/span\u003e\u003cspan address=\"10.1016/j.ihjccr.2018.08.007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Sinus of Valsalva, aneurysm, unruptured, patch repair, SoVA","lastPublishedDoi":"10.21203/rs.3.rs-7171538/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7171538/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eSinus of Valsalva aneurysm (SoVA) is a rare, acquired or congenital heart anomaly in which one or more of the aortic sinuses become abnormally dilated. SoVAs are commonly asymptomatic and found incidentally on cardiac imaging studies. Unruptured SoVA may be associated with various forms of arrhythmia, angina, or exertional dyspnea. Symptom severity and type depend on the size and location of SoVA, as well as the degree of concomitant aortic regurgitation. Less frequently, SoVA may rupture and lead to heart failure and even cardiovascular collapse.\u003c/p\u003e\u003ch2\u003eCase presentation\u003c/h2\u003e\u003cp\u003eWe report a case of a 76-year-old male incidentally diagnosed with two large, unruptured saccular sinus of Valsalva aneurysms, involving the left and right coronary sinuses, who underwent successful patch repair.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eSoVAs are rare cardiac abnormalities which, when large or multiple, have an elevated risk of rupture leading to hemodynamic compromise and death. Timely surgical management should be prioritized in unique cases of large, numerous SoVAs.\u003c/p\u003e","manuscriptTitle":"Patch Repair of Double Sinus of Valsalva Aneurysms","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-27 05:49:37","doi":"10.21203/rs.3.rs-7171538/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-19T18:56:50+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-28T03:27:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-25T03:51:05+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-23T19:12:42+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-20T04:19:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"119213520276623811590336963501203409206","date":"2025-08-19T00:09:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"247675484260607182464020030483626632581","date":"2025-08-16T03:00:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"67082870419177085787327471296406923044","date":"2025-08-15T16:36:13+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-15T16:17:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"305610123383150968837400707661251031212","date":"2025-08-15T15:52:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"144896731478128992808077438850335178779","date":"2025-08-15T15:51:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"278721909785325674926897655941141576293","date":"2025-08-15T15:39:24+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-15T15:33:20+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-22T13:18:30+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-22T13:16:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Cardiothoracic Surgery","date":"2025-07-20T19:25:18+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"51e5b8ba-692b-4a48-9b05-cb541baed5a3","owner":[],"postedDate":"August 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-06T16:40:01+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-27 05:49:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7171538","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7171538","identity":"rs-7171538","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}