Transcatheter Closure of Giant Ruptured Sinus of Valsalva Aneurysm

A 41-year-old woman presented with paroxysmal chest pain, dyspnea, and palpitations, and a continuous heart murmur was heard over the right upper and lower sternal borders. Transthoracic echocardiography revealed a giant ruptured sinus of Valsalva aneurysm (SOVA), which had dislodged and ruptured into the right atrium adjacent to the tricuspid valve. The diameter of the aortic end of the defect was 4 mm. Interestingly, this windsock SOVA swung into the right atrium and the right ventricle during different phases of the cardiac cycle (Figure 1 and Movie I in the online-only Data Supplement). Biatrial enlargement showed that the left atrial volume was 54 mL and the right atrial volume was 91 mL. We attempted to perform a transcatheter closure of this ruptured giant SOVA at the aortic end of the rupture site. Figure 1. A , Transthoracic echocardiogram obtained in the aortic short-axis view showing a giant windsock sinus of Valsalva aneurysm (SOVA), which had become dislodged and ruptured into the right atrium. It was adjacent to the tricuspid valve during systole. B , The SOVA swung into the right ventricle during diastole. …