A 60-year-old previously healthy woman was admitted with exertional dyspnea. She was a non-smoker and -drinker. Physical examination was insignificant, except for a soft early diastolic murmur. Further examination was performed. Blood tests and electrocardiogram were normal. Transesophageal echocardiography revealed a giant unruptured left sinus of Valsalva aneurysm (SVA) with spontaneous echo contrast, which severely compressed the left ventricle (Fig. 1, arrow, Video 1, 2). The 64-multidetector computed tomography angiogram with iodinated contrast injection was used to demonstrate the giant aneurysm with a maximal diameter of 8.7 cm, and the left main coronary artery was not involved (Fig. 2).
Figure 1.
On two-dimensional transthoracic echocardiogram, arrow points to a large aneurysm in the right coronary leaflet involved in basal septum. AAO - ascending aorta; LA - left atrium; LV - left ventricle; RV - right ventricle
Figure 2.
Color Doppler echocardiography showing perforation (arrow) of the aneurysm as a cause of aortic regurgitation. AAO - ascending aorta
Because of a high risk of thrombus formation in SVA and the potentiality of a fatal rupture, an aneurysmectomy (Fig. 3, arrow) and reconstruction of the coronary arteries were performed under cardiopulmonary bypass. The postoperative course was uneventful. Pathology results revealed the breakage of the intimal elastic fiber, lymphocytic infiltration, and fibroplastic proliferation of the tunica media. Calcification foci and hyaline degeneration with cystic degeneration were also observed in the tunica media (Fig. 4).
Figure 3.
Three-dimensional transesophageal echocardiography demonstrated multiple perforations (black arrows) on the aneurysm
Figure 4.
Microscopy (x50), hematoxylin and eosin stain
Video 1
Transesophageal echocardiography revealing a giant unruptured left sinus of Valsalva aneurysm.
Video 2
Transesophageal echocardiography revealing the aneurysm severely compressing the left ventricle.
Acknowledgements
The study was supported by the National Science & Technology Pillar Program during the 12th Five-year Plan Period (No.2011BAI11B20) and the National Research Foundation of Nature Science (No.81370413), China.
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.