Sinus of Valsalva Rupture With Dissection Into the Interventricular Septum
Diagnosis by Echocardiography and Magnetic Resonance Imaging
A 27-year-old previously healthy woman presented with a 3-month-long history of dyspnea after a nonspecific flu-like illness. Congestive heart failure was diagnosed clinically and confirmed radiographically. A transthoracic echocardiogram demonstrated rupture of the sinus of Valsalva with dissection into the interventricular septum (Figures 1 and 2⇓). Severe early diastolic regurgitation into the false, noncommunicating cavity was observed within the septum, as well as moderate left ventricular chamber dilatation, distortion of the anteromedial papillary muscle, and consequent severe mitral regurgitation. A transesophageal echocardiogram showed the site of the rupture with flow into the false cavity (Figure 3, A and B). These findings were confirmed on magnetic resonance imaging (MRI; Figure 4). The patient was stabilized medically and underwent surgical repair. The postoperative transesophageal echocardiogram demonstrated elimination of the regurgitation into the false cavity and decreased mitral regurgitation (although still moderate) and a much smaller aneurysmal sac.
Dissections into the interventricular septum from rupture of the sinus of Valsalva are rare; only 4 similar cases have been reported with an intact false lumen in the left ventricle.1 No previous MRI images of this finding have been reported. Although the MRI images did not provide any extra information with regard to the diagnosis, it did give our surgeons a better 3D appreciation when approaching the surgical repair.
The authors acknowledge Dr Michelle Noga’s contributing the MRI for this case.