PMC9623089_01
(A,B) Electrocardiography images.
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The 18-lead electrocardiogram revealed sinus bradycardia, second-degree atrioventricular block, and ST-segment elevation in leads II, III, aVF, and V3R-V5R (Figure 1). After opening the pericardial sac, a huge, dull red aneurysm was seen (Supplementary Figure 1A). The orifice of the RSVA neck was ~25 mm in diameter and was closed with a continuous suture and a bovine epicardial patch of suitable size (Supplementary Figures 1B,C).
Transthoracic echocardiography images. (A) Transthoracic echocardiography showing a giant right sinus of Valsalva aneurysm in the long-axis view and (B) the aortic root. (C) The compressed RCA is displaced with an accelerating velocity of 150 cm/s. (D) The right ventricular systolic fraction is reduced (31.9% RVFAC). RSVA, right sinus of Valsalva aneurysm; RV, right ventricle; LV, left ventricle; LA, left atrium; Aor, aorta; NCS, noncoronary sinus; LCS, left coronary sinus; RA, right atrium; RVFAC, right ventricular fractional area change.
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Transthoracic echocardiography (Supplementary Video 3) demonstrated a giant RSVA in a prothrombotic state with a small degree of pericardial effusion (Figures 2A,B). The RCA was displaced and compressed with an accelerating velocity (Figure 2C). The right heart was enlarged and right ventricular systolic function was reduced (right ventricular fractional area change of 31.9%, tricuspid annular plane systolic excursion of 13 mm, Figure 2D, Supplementary Video 4).
Coronary computed tomography angiography (CTA) images. CTA images showing the RSVA (A), which ruptured to the pericardium [red arrow (B)], and some contrast medium leakage into the pericardial sac [yellow arrows (B)]; the severely compressed RCA is stretched across the aneurysmal surface [black arrows (C)]; the proximal segment of RCA was relatively slender (D). RSVA, right sinus of Valsalva aneurysm; LV, left ventricle; NCS, noncoronary sinus; LCS, left coronary sinus; RCA, right coronary artery.
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Coronary computed tomography angiography (CTA) revealed a huge RSVA (65 mm x 70 mm) with contrast medium leakage into the pericardial sac, revealing a rupture of the RSVA (Figures 3A,B); however, it did not show signs of tamponade The RCA was severely compressed and stretched by the giant aneurysm (Figure 3C). and its proximal segment was relatively slender (Figure 3D).