Ruptured sinus of Valsalva aneurysm

Case contributed by Aws Hamid MD MS

Presentation

A middle-aged female patient presented to the emergency department with chest pressure.

Patient Data

Age: 50 years
Gender: Female

ECG-gated cardiac CT shows that the right posterior (noncoronary) sinus of Valsalva has ruptured into the right atrium.

Orthogonal planes of gated cardiac CTA demonstrate a noncoronary sinus of Valsalva aneurysm that has ruptured into the right atrium (white arrow). A jet of contrast through the defect into the right atrium is also seen (black arrow).

Case Discussion

Ruptured Valsalva sinus aneurysm.

Sinus of Valsalva aneurysm appears as a saccular outpouching from the sinus of Valsalva. When it ruptures, it most commonly ruptures into the right ventricle, followed by the right atrium. The aorto-cardiac shunt (left to right shunt) can lead to insidious heart failure.

Extracardiac rupture is rare and can lead to cardiac tamponade, which carries a higher mortality rate. The treatment option is cardiopulmonary bypass surgery.

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