PMC7680238_01
echographic image showing the passage of blood flow from the right Valsalva sinus to the right atrium
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F1
TEE was quickly performed to characterize the observed shunt and showed a rupture of the right Valsalva sinus in the right atrium with a channel of 6 mm (Figure 1).
thoracic CT angiography in axial section, showing a passage of contrast material through the right coronary sinus to the right atrioventricular junction
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F2
A computerized tomography (CT) scan was performed and showed the presence of aneurysmal dilatation of the Valsalva sinus (44 mm) with an iodine contrast leakage through the right coronary sinus to the right atrioventricular junction (Figure 2).
surgical view showing the rupture of the right sinus of Valsalva after complete transverse aortotomy
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F3
Peroperative assessment highlighted a tricuspid aortic valve with thin leaflets, dilatation of the right Valsalva sinus with presence of a large perforation (about 1 cm) at the base of the aortic annulus and under the ostium of right coronary artery (Figure 3).
surgical view showing the final result after pericardial patch repair
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F4
After trimming, the orifice was closed using a pericardial patch passing by the aortic way (Figure 4).