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.