Ruptured valsalva sinus aneurysm to pericardium simulated aortic root dissection

Abstract

Ruptured valsalva sinus aneurysm to pericardium is a rare condition. Here, we described a case presented with tamponade. Initially, hemopericardium was partially drained and then, imaging evaluations were done. Transesophageal echocardiography showed limited dissection of aortic sinus and CT angiography of the ascending aorta showed deformed dilated right coronary sinus. Besides, surgery showed that windsock tract of the right coronary sinus had ruptured into the pericardium with avulsed right coronary aortic cusp. This case indicated a rare cause of cardiac tamponade and insufficiency of imaging modalities for making an accurate diagnosis.

Keywords: Cardiac Tamponade; Dissection; Echocardiography; Sinus of Valsalva.

Figure 1.. CT Scan Image of the Aortic Sinus that Showed Dilated Distorted RCS

Figure 2.. TEE Images

First image (top) shows free space in the right coronary-noncoronary commissure. The second image shows the echogenic line as a dissecting flap in cross section. The third image shows the echogenic line as a dissecting flap in long axis. The forth image shows the connection orifice of the aorta and the left ventricle.