The Ball-Valve Mechanism: Multimodality Imaging of Dynamic Tricuspid Obstruction From a Migratory Ruptured Sinus of Valsalva Aneurysm.

This manuscript presents a rare case of a ruptured non-coronary sinus of Valsalva aneurysm into the right atrium, forming a giant migratory sac that caused dynamic tricuspid valve obstruction via a diastolic ball-valve mechanism. Transthoracic echocardiography raised the initial suspicion, cardiac computed tomography excluded dissection and visualized its mobility, and transesophageal echocardiography definitively characterized the rupture site and captured the real-time obstructive pathophysiology. This multimodality imaging approach was pivotal in guiding urgent surgical intervention.