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.