Rupture of a Nonaneurysmal Left Sinus of Valsalva Into the Pericardium.

BACKGROUND

Acute type A aortic syndrome involving a nonaneurysmal sinus of Valsalva (SOV) without predisposing factors is exceptionally rare. The contribution of remote blunt chest trauma (BCT) in delayed aortic root pathology and aortic regurgitation remains uncertain.

CASE: A 71-year-old patient presented with acute chest tightness and a large nontamponading pericardial effusion. Computed tomography angiography was inconclusive, but transesophageal echocardiography (TOE) identified rupture of a nonaneurysmal left SOV and left aortic cusp causing severe aortic regurgitation. Urgent surgical repair was successful. No clear etiology was identified, though a bicycle-related BCT 6 years earlier was considered contributory, albeit unproven.

DISCUSSION: This case highlights the rarity and diagnostic challenge of nonaneurysmal left SOV rupture without clear predisposing conditions.

TAKE-HOME MESSAGES: Transesophageal echocardiography is essential when computed tomography angiography is inconclusive for acute type A aortic syndrome. After BCT, comprehensive cardiac evaluation and long-term follow-up may identify delayed cardiac complications, even in patients without prior cardiac disease.