PMC8695605_01
Two-dimensional transthoracic echocardiographic images. (A) Long-axis view of the left ventricle showing an echo-lucent cavity in the left-ventricular myocardium with abnormal blood flow on color Doppler (arrow). (B) Short-axis view at the MV (mitral valve) level also showing the echo-lucent cavity with partitions in the left-ventricular myocardium and abnormal blood flow on color Doppler. AO, aorta; LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle; RVOT, right ventricular outflow tract.
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F1
An echocardiogram revealed a left SVA that ruptured into the left-ventricular myocardium, forming an echo-lucent cavity (Figure 1).
(A,B) CT angiogram images showing the anatomical profile of IPA (white arrow) and perforation (black arrow). (C,D) CMR LGE images showing the high signal intensity of the IPA with a distal low signal intensity ( ), and a linear high signal intensity (white arrow) of the IPA wall and partitions. LCS, left coronary sinus.
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F2
Furthermore, CT angiograms better captured a large, left-ventricular, IPA arising from a small perforation in the left SVA (Figures 2A,B). With CMR examination, late gadolinium enhancement (LGE) clearly demonstrated the left-ventricular IPA with distal thrombus and a linear enhancement of the IPA wall, compatible with myocardial fibrosis (Figures 2C,D).
Post-operation two-dimensional transthoracic echocardiographic images. (A) Short-axis view at the aortic valve level showing the perforation of the left sinus of Valsalva repair and (B) non-standard short-axis view showing the cessation of abnormal blood flow on color Doppler.
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F3
Three weeks after surgery, a follow-up echocardiogram demonstrated the cessation of the abnormal blood flow in the left sinus of Valsalva (Figure 3).