Large Sinus of Valsalva Aneurysm Complicated by Thrombus Formation

Abstract

Sinus of Valsalva aneurysm (SOVA) is an unusual cardiac anomaly that is potentially fatal with rupture. It is often asymptomatic but has various presentations. We describe a case of a 67-year-old male who presented with atypical chest pain. Transthoracic echocardiogram and cardiac computed tomography scan confirmed a large SOVA complicated by thrombus formation and compression of the left atrium and left ventricular outflow tract. The patient successfully underwent a Bentall procedure-surgical aortic aneurysm repair with mechanical aortic valve conduit. We discuss several clinical decision-making branch points to highlight the complexity of managing this condition. Even in asymptomatic or minimally symptomatic patients with SOVA, surgery may be indicated if the aneurysm meets the criteria for size or has thrombus formation or compressive effects.

Keywords: SOVA; cardiac anomaly; sinus of Valsalva aneurysm.

Figure 1.

(A) Transthoracic echocardiogram shows a filling defect within the noncoronary cusp after administration of ultrasound contrast, suggestive of a thrombus. (B) Computed tomography coronary angiogram shows aneurysmal noncoronary sinus (*indicates dilated noncoronary cusp aneurysm, arrow indicates thrombus). (C) Intraoperative image shows aortic root at the level of sinus of Valsalva and the noncoronary cusp aneurysm (arrow).