Table 2.

Comparison table of treatment options for sinus of Valsalva aneurysms

Interventions	Recommendations	Advantages	Disadvantages
Medical management	Insufficient for definitive treatment. Blood pressure control with antihypertensives such as angiotensin-converting enzyme inhibitors, beta-blockers, or calcium channel blockers to reduce aortic wall stress should be used as a temporary measure until definitive surgical repair or transcatheter closure can be done	Reduces the chances of rupture for cases of unruptured SoVAs	Not definitive treatment
Surgical repair	Surgery remains the definitive treatment for SoVAs. Recommended for symptomatic, large, or rapidly progressive aneurysms and all ruptured aneurysms. The 2010 American Guidelines for Thoracic Aortic Disease recommend considering surgical repair for aneurysms greater than 5.5 cm, greater than 5 cm in patients with BAVs, greater than 4.5 cm in the setting of connective tissue disease, or a yearly growth rate that exceeds 0.5 cm	Can address concurrent cardiac issues such as VSDs or aortic valve dysfunction	Higher risk for complications such as bleeding, infection, or heart failure. Additionally, surgical repair prolongs hospital stay and recovery times compared to TCC
Transcatheter closure	Emerging minimally invasive technique used to treat both ruptured and unruptured aneurysms	Advantages include reduced surgical risks, avoiding heart surgery, and shortened hospital length and recovery times	Has potential complications such as residual shunt, embolization, or device malposition, which are generally manageable

SoVA: Sinus of Valsalva aneurysm; BAVs: Bicuspid aortic valve; VSDs: Ventricular septal defects; TCC: Transcatheter closure.