https://orcid.org/0000-0002-1131-1256
A 64-year-old woman was admitted to our hospital for recurrent chest pain lasting over a year and worsening respiratory distress over 2 days. She had a 10-year history of emphysema and asthma but no history of chronic diseases such as hypertension, diabetes, or coronary heart disease. Upon admission, her oxygen saturation was 88%. Emergency bedside chest X-ray revealed a left pneumothorax with 30% lung compression and a right pneumothorax with 10% lung compression. The echocardiogram showed a spherical anechoic mass, approximately 47 mm × 42 mm in size, within the interatrial septum on the four-chamber view (Panel A). The short-axis view of the great arteries in the sub-xiphoid view revealed that the non-coronary sinus of Valsalva was connected to the anechoic mass, which had a 20-mm-wide ostium (Panel B). Pulse wave spectral Doppler demonstrated a low-speed shunt signal at the ostium. The dimensions of each chamber and the left ventricular systolic function were normal. Contrast-enhanced cardiac computed tomography showed contrast agent filling the mass in the atrial septum, ∼42 mm × 43 mm in size, which was connected to the non-coronary Valsalva sinus and resembled a ‘bulb’ (Panels C and D). A rupture of the non-coronary Valsalva sinus aneurysm into the atrial septum was diagnosed. The patient underwent bilateral closed thoracic drainage due to bilateral pneumothorax, and her symptoms were relieved. Surgery was declined, and regular follow-up was recommended. Rupture of a non-coronary Valsalva sinus aneurysm into the atrial septum is extremely rare. Multimodal imaging is essential for diagnosis.
Funding: Beijing Natural Science Foundation (L222152).
Data availability: No data were generated or analysed for or in support of this paper.
Author notes
Zhao Wang and Jialong Wu contributed equally to this work.
Conflict of interest: None declared.
