JACC. Case reports · 2026
Ruptured Sinus of Valsalva Aneurysm With 2 Simultaneous Fistulas to the Left Ventricular Outflow Tract.
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Mitsumizo Ryoto, Matsukawa Ryuichi, Uchida Takayuki, Nishi Jun-Ichiro
Аннотация
BACKGROUND: Sinus of Valsalva aneurysm (SOVA) rupture usually forms fistulas into right heart chambers; left-sided ruptures are exceedingly rare.
CASE SUMMARY: A 73-year-old woman presented for evaluation of ST-segment depression in V5 and V6 and moderate aortic regurgitation. Imaging revealed a noncoronary cusp-origin SOVA with 2 simultaneous fistulas into the left ventricular outflow tract. She remained asymptomatic with stable hemodynamics, allowing elective surgical repair with patch closure, direct suture, and bioprosthetic valve replacement.
DISCUSSION: The left-to-left shunt decompressed the aneurysmal sac, preventing acute heart failure. Unlike typical left-to-right ruptures, these favorable flow dynamics allowed safe delayed intervention. Histopathological examination suggested age-related degeneration rather than congenital or inflammatory etiology.
TAKE-HOME MESSAGES: This is the first reported case of a noncoronary cusp SOVA rupturing into 2 left ventricular outflow tract fistulas. Careful hemodynamic assessment is crucial, as select patients may benefit from elective rather than urgent repair.
CASE SUMMARY: A 73-year-old woman presented for evaluation of ST-segment depression in V5 and V6 and moderate aortic regurgitation. Imaging revealed a noncoronary cusp-origin SOVA with 2 simultaneous fistulas into the left ventricular outflow tract. She remained asymptomatic with stable hemodynamics, allowing elective surgical repair with patch closure, direct suture, and bioprosthetic valve replacement.
DISCUSSION: The left-to-left shunt decompressed the aneurysmal sac, preventing acute heart failure. Unlike typical left-to-right ruptures, these favorable flow dynamics allowed safe delayed intervention. Histopathological examination suggested age-related degeneration rather than congenital or inflammatory etiology.
TAKE-HOME MESSAGES: This is the first reported case of a noncoronary cusp SOVA rupturing into 2 left ventricular outflow tract fistulas. Careful hemodynamic assessment is crucial, as select patients may benefit from elective rather than urgent repair.