Classic ‘wind-sock’ appearance of a right SOV aneurysm

Sinus of Valsalva (SOV) aneurysms are more common in males (4:1) and in those of Asian descent (prevalence of 0.46-3.5% in different surgical series).

SOV aneurysms are most commonly seen in the right sinus (65-85%), followed by the non-coronary sinus (10-30%), and are rare in the left sinus (<5%).

Clinically SOV aneurysms are associated with bicuspid aortic valves (~15-20%), perimenbranous VSDs (30-60%) and aortic regurgitation (50%). They can also serve as a nidus for thrombus formation.

Most ruptured SOV aneurysms occur between puberty and age 40, and are characterised by a loud continuous ‘machine-type’ murmur accentuated in diastole. Right and non-coronary SOV aneurysms typically rupture into the RV, followed by the RA (respectively), whereas left SOV aneurysms are usually less clinically significant and may rupture into the LVOT or LA.