Case Report
A 28-year-old man was admitted to hospital with dull chest pain for 1 month. Chest radiography showing cardiac enlargement (Fig 1A). Transthoracic and transesophageal echocardiography showed ruptured Valsalva right sinus aneurysm into the right ventricular outflow tract and right coronary valve out into the left ventricular outflow tract with moderate aortic regurgitation (Fig 1B-1C, Video 1 in the Data Supplement). Therefore, we initially considered that aortic regurgitation might be caused by rupture of aortic sinus tumor resulting in right coronary valve prolapse.
Ventricular septal defect was observed intraoperatively, and the tumor burst into the right ventricular outflow tract through the ventricular septal defect. We resected the tumor, repaired it with suture and reinforced it, and repaired the ventricular septal defect with mesh. No aortic valve was damaged during the operation. Transesophageal echocardiography after cardioversion revealed the absence of broken shunt, but moderate-to-severe eccentric regurgitation of the aortic valve (Fig 1D-1E, Video 2 in the Data Supplement). The aortic valve was then explored again, and the left coronary lobe of the aortic valve was perforated with a hole of about 0.3cm (Fig 1F). After evaluation, the aortic valve was replaced. Transesophageal echocardiography showed absence of shunt and no abnormal periaortic flow. Postoperative pathology revealed hyperplasia of aortic valve fibrous tissue, hyalinoid and mucoid changes (Fig 1G-1H). After re-examination, the patient had no history of infective endocarditis and trauma, etc., and was considered to have spontaneous rupture and perforation of the main artery flap.