Discussion
Aortic sinus tumor is a rare congenital disease[1] that most commonly affects the right coronary
sinus (RCS) and non-coronary sinus (NCS) and right coronary sinus (LCS)[2]. It may be accompanied by ventricular septal
defect, aortic regurgitation [3] and so on. Aortic
valve rupture and perforation is more common in infection, trauma,
invasive operation [4-5]. It is rare to see
spontaneous perforation of the valve itself resulting in aortic
regurgitation. We report here a rare and complex case of severe aortic
regurgitation caused by SVA rupture with spontaneous valve perforation.
The unique regurgitation pattern begins with a rupture of the right
coronary sinus of the aorta, enters the right ventricular outflow tract
through the interventricular septum, and also passes through the
spontaneous rupture of the LCC pore (Fig. 1I). It is difficult to
accurately diagnose this patient’s regurgitation using transthoracic
echocardiography alone. At the same time, perforation (rupture) may have
affected the progression of his disease, and this unique regurgitation
is highly prone to severe acute heart failure, because spontaneous
perforation is generally small, preoperative esophageal ultrasound did
not indicate aortic valve perforation. Intraoperative transesophageal
echocardiography is a versatile diagnostic and monitoring tool that
facilitates surgical decision making in the operating room[6]. The pathogenesis of this extremely rare
severe aortic insufficiency was accurately diagnosed and successfully
treated by real-time transesophageal echocardiography combined with
surgery.
Conflicts of interest: All authors have read and approved
submission of the manuscript and have no conflict of interest to
disclose.
Informed consent: Written informed consent was obtained from
the patient for the publication of the case report and the accompanying
images.
Data availability statement: The data that support the findings
of this study are available from the corresponding author upon
reasonable request.