Sinus of Valsalva Aneurysm (SOVA) Synopsis- Transesophageal Echocardiography Guide

**Sinus of Valvsalva aneurysm (SOVA)** Echo Features
Diagnostic TEE views	What to look for in 2D and 3D TEE	What to look for in Colour Doppler	What to look for in Spectral Doppler
ME AV SAX ME AV LAX ME 5 Ch ME RV in/outflow Deep TG LAX	Sinus dilatation Single (congenital) or mutiple (acquired) sinus involvement SOVA location + measure size Identify cardiac chamber which SOVA expands into Identify presence of windsock deformity of the SOVA which expands during systole Echo dropout at tip of the windsock may indicate rupture Sinus thrombus RV/LV volume overload /dilatation RV/LV systolic function	Presence of ruptured versus unruptured SOVA Flow is typically turbulent or laminar in thrombosed and low flow state Identify location of rupture and fistula formation Determine shunt direction	Determine peak/mean pressure gradients across intracardiac fistulae Determine the timing and duration of fistula flow with reference to the ECG Aortic-intracardiac fistula demonstrates continuous systolic + diastolic high velocity unidirectional flow VSD demonstrates high velocity systolic + low velocity diastolic flow If both conditions are present, continuous high velocity aortic-intracardiac fistula flow may mask the VSD Doppler spectrum

Associated conditions
Condition name	Diagnostic TEE views	What to look for in 2D and 3D TEE	What to look for in Colour Doppler	What to look for in Spectral Doppler
VSD	ME 5 Ch ME 4 Ch ME AV LAX ME RV in/outflow TG SAX/LAX Deep TG LAX	Location + size of defect Type (subarterial/supracristal > perimembranous)	Subarterial – Colour flow sub-pulmonic (RV in/outflow) Perimembranous – Colour flow subtricuspid within anterior IVS (RV in/outflow, TG SAX)	Peak/mean pressure gradients Restrictive Vs unrestrictive High velocity systolic L to R flow
BAV/Aortopathy	ME AV SAX/LAX ME AscAo SAX/LAX UE AoArch SAX/LAX	Bicuspid/Tricuspid Valve Cusp Prolapse Aortic Regurgitation Aortopathy (dilated or aneurysmal +/-dissection) Aortic dimensions Repair unlikely if thickened, rolled, and calcified cusps	Colour flow across AV to assess severity AR Eccentric jet (cusp prolapse) Vs central (root dilatation)	AV Peak/mean pressure gradients, AV VTI AR, PHT/Deceleration time
Endocarditis		Valvular mobile mass associated with SOVA. Assess other valves for vegetations Assess for valve perforation, local abscess and fistulae formation	Valve regurgitation/stenosis Multiple jets in valve perforation Abscess with fistuale show complex intracardiac communications
RVOT Obstruction/Pulmonary valve stenosis	UE AoArch SAX ME AscAo SAX ME RV in/outflow TG RV in/outflow	Prolapse RCC Pulmonary valve morphology, mobility Sub-pulmonic valve narrowing/shelf Post stenotic dilatation of pulmonary artery	Pulmonary stenosis (systolic turbulence post PV) Subpulmonic stenosis (systolic turbulence RVOT) Pulmonary regurgitation	PV Peak/mean pressure gradient Subpulmonic obstruction gives dagger shaped CW Doppler

Other Related Anomalies:ASD, PDA, Coarctation of the aorta, Gerbode effect (shunt LV to RA)