Aneurysm of the right sinus of Valsalva dissecting into the interventricular septum - A case report

Aneurysm of the sinus of Valsalva is rare and usually presents after rupture. Dissection of the interventricular septum by the aneurysm is even more rare. A 50-year-old man presented with a 3-month history of nonproductive cough and exertional dyspnea. Cardiac auscultation revealed a grade III/VI "to and fro" murmur along the left sternal border. Electrocardiography showed intermittent Mobitz type II atrioventricular block. A right posteroseptal accessory pathway was also suspected. Transthoracic and transesophageal echocardiography revealed an aneurysm of the right sinus of Valsalva, dissecting into the interventricular septum, and severe aortic regurgitation, Aortography also confirmed the presence of an aneurysm of the right coronary sinus, extending into the interventricular septum. Selective left coronary arteriography showed 70% stenosis of the proximal left anterior descending artery and collateral vessels from the left circumflex artery to the right coronary artery. The patient underwent open heart surgery to close the ostium of the aneurysm, aortic valve replacement, and coronary bypass grafting of the left anterior descending artery and the right coronary artery. The patient was well upon follow-up after the operation.