Early diagnosis and Surgical Management of a Ruptured Sinus of Valsalva Aneurysm: A Case report

Background Ruptured Sinus of Valsalva aneurysm (RSOVA) is a rare and fatal cardiac condition characterized by an abnormal outpouching of the aortic root that ruptures into adjacent cardiac chambers typically the right atrium (RA) or right ventricle (RV). Due to its asymptomatic presentation, it often poses diagnostic and therapeutic challenges. We report this case to highlight role of early diagnosis, multimodal imaging and timely surgical intervention in improving outcomes. Case presentation: A 33-year-old hypertensive man presented with epigastric pain, abdominal discomfort, fatigue with weakness, breathlessness corresponding to New York Heart Association (NYHA) Grade II, pedal edema, palpitations, and signs of heart failure. Clinical examination revealed a bounding pulse, elevated jugular venous pressure, and a continuous murmur. 2D Echo, Cardiac MSCT + Aortogram, HRCT chest confirmed a RSOVA originating from the right coronary cusp (RCC) into RA, with severe aortic regurgitation (AR), severe mitral (MR) and tricuspid regurgitation (TR), and left ventricular systolic dysfunction. RSOV repair was done through sternotomy, excision of the aneurysmal sac and closure with a polytetrafluoroethylene (PTFE) patch. Postoperative management included antibiotics, cardiovascular medications, and diuretics. Follow-up echocardiography demonstrated successful repair without residual shunting, though moderate mitral regurgitation and ventricular dysfunction persisted. Conclusion A thorough clinical history, physical examination, timely diagnostic approach and personalized operative and treatment regimen is the cornerstone of the case. This report underscores the need for awareness of this asymptomatic rare condition and benefit of comprehensive individualized approach.