ArticleJACC. Case reports2026
Ruptured Sinus of Valsalva Aneurysm With 2 Simultaneous Fistulas to the Left Ventricular Outflow Tract.
Article in JACC. Case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundSinus of Valsalva aneurysm (SOVA) rupture usually forms fistulas into right heart chambers; left-sided ruptures are exceedingly rare. CASE SUMMARY: A 73-year-old woman presented for evaluation of ST-segment depression in V5 and V6 and moderate aortic regurgitation. Imaging revealed a noncoronary cusp-origin SOVA with 2 simultaneous fistulas into the left ventricular outflow tract. She remained asymptomatic with stable hemodynamics, allowing elective surgical repair with patch closure, direct suture, and bioprosthetic valve replacement. DISCUSSION: The left-to-left shunt decompressed the aneurysmal sac, preventing acute heart failure. Unlike typical left-to-right ruptures, these favorable flow dynamics allowed safe delayed intervention. Histopathological examination suggested age-related degeneration rather than congenital or inflammatory etiology. TAKE-HOME MESSAGES: This is the first reported case of a noncoronary cusp SOVA rupturing into 2 left ventricular outflow tract fistulas. Careful hemodynamic assessment is crucial, as select patients may benefit from elective rather than urgent repair.
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