Incidental Finding of an Aneurysm of the Sinus of Valsalva in a Young Woman: A Management Dilemma.

A sinus of Valsalva aneurysm (SOVA) is an aneurysm of the aortic root between the aortic valve annulus and the sinotubular junction. Unruptured SOVAs are often asymptomatic and discovered incidentally during cardiac imaging. Rupture of a SOVA can lead to acute or insidious hemodynamic compromise. When SOVAs are diagnosed, they are accompanied by the decision to recommend surgical intervention versus conservative medical therapy. We are reporting a challenging case of a young female patient presenting with an incidental finding of an aneurysm of the sinus of Valsalva. A previously healthy 21-year-old woman with no prior medical history was referred for an evaluation of recurrent syncopal episodes. She was otherwise healthy without any pertinent medical history. An incidental finding of an aneurysm of the sinus of Valsalva involving the right coronary cusp was noted, measuring 11 mm (width) x 10 mm (depth) on the echocardiogram. The patient presented a clinical decision dilemma regarding the best strategy for treatment and follow-up. She was referred to cardiothoracic surgery for further evaluation. Her young age, unusual presentation, and remaining asymptomatic contributed to the decision to continue with a conservative approach. She has continued to be evaluated in the outpatient setting by serial echocardiograms. These studies have remained stable without progression of the aneurysm. After two years of close follow-up, the patient has demonstrated continued stability of the aneurysm. In light of the guidelines regarding aortic disease, it remains of the utmost importance to keep patients and their presenting symptoms at the center of decision-making. Conservative management with close outpatient follow-up was successful in keeping our young asymptomatic patient and her aneurysm stable. However, there remains a role for surgical intervention, when appropriate, in other clinical scenarios.