J Cardiovasc Ultrasound.  2008 Sep;16(3):93-95. 10.4250/jcu.2008.16.3.93.

Spontaneous Perforation of Sinus of Valsalva without Associated Aortic Pathology

• Kang MK
• Choi BR
• Jeong YH
• Kim JW
• Kwak CH
• Seo MG
• Ahn YJ
• Cho JH
• Jeon KN
• Hwang JY

• KMID: 1486586
• DOI: http://doi.org/10.4250/jcu.2008.16.3.93

Abstract

The spontaneous perforation of sinus of Valsalva without congenital anomaly such as aneurysm and trauma has not been reported. We report a 66-year-old female presenting with ST elevation myocardial infarction due to compressing the proximal part of right coronary artery by hematoma attributed to spontaneous perforation of sinus of Vaslava. The patient was stabilized after surgical primary repair.

Keyword

Sinus of Valsalva; Hematoma; ST elevation myocrdial infarction

MeSH Terms

Aged
Aneurysm
Coronary Vessels
Female
Hematoma
Humans
Myocardial Infarction
Sinus of Valsalva

Figure

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  Fig. 1 The routine Computed Tomography (A) at arrival showed hemopercardium (white arrow) and large hematoma (arrowhead) adjacent to right coronary artery. Eighteen hours later, she complaint recurrent chest pain and the 64-channel coronary Multidetector Computed Tomography (MDCT) checked. The MDCT (B) showed increased size of hematoma (arrowhead) and the extravasation of contrast from sinus of Valsalva (white arrow). The right coronary artery (black arrow) was surrounded and compressed by the large hematoma.

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  Fig. 2 The transthoracic echocardiography (A) and transesophageal echocardiography (B) showed hyperechogenic mass-like lesion (white arrow and arrowhead) at adjacent to right ventricle wall and moderate amount pericardial effusion.

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  Fig. 3 The coronary angiogram showed normal coronary arteries without any significant stenosis and rupture.

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  Fig. 4 The electrocardiogram showed ST elevation at II, III, aVF and ST depression of V4-6 with complete atriovenricular block.

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  Fig. 5 Intraoperative image showed 0.5 cm sized transverse rupture of sinus Valsalva (white arrow) at just above commissure between noncoronary cusp and right coronary cusp. The proroximal right coronary artery (black arrow) surrounded and compressed by large hematoma (arrowhead) bursting into the right ventricle, right atrium and pericardial space.

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