Sinus of Valsalva Aneurysm Rupture Causing Ventricular Septal Dissection With Left Ventricular Penetration.

BACKGROUND

Rupture of a sinus of Valsalva aneurysm is most often congenital, resulting from inherent weakness at the aortic-annular junction. Rupture into the interventricular septum is a rare complication.

CASE SUMMARY: A 58-year-old man presented with recurrent chest tightness consistent with NYHA functional class III symptoms and hypotension (blood pressure: 103/43 mm Hg). Transthoracic echocardiography, transesophageal echocardiography, and computed tomography angiography demonstrated rupture of a right coronary sinus aneurysm into the interventricular septum, forming a dissection that communicated with the left ventricle via 2 defects. Emergent surgical repair led to complete resolution of the dissection.

DISCUSSION: This case illustrates the diagnostic challenges associated with rupture of a sinus of Valsalva aneurysm complicated by ventricular septal dissection. It emphasizes the critical role of multimodal imaging in detecting left ventricular involvement, and it underscores the necessity of prompt surgical intervention to reduce mortality.

TAKE-HOME MESSAGE: Early identification using multimodal imaging and immediate surgical repair are essential for favorable outcomes in rare cases of sinus of Valsalva aneurysm rupture complicated by ventricular septal dissection and left ventricular penetration.