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Diagnosis of Aortic Annular Avulsion with Right Coronary Sinus Pseudoaneurysm

Overview

This case study presents a rare instance of aortic annular avulsion with a right coronary sinus pseudoaneurysm and aorto-left ventricular communication. Multimodal imaging was essential for diagnosis and surgical planning.

Background

Aortic annular avulsion is a critical condition that can lead to severe complications if not diagnosed promptly. The integration of multimodal imaging techniques is vital for accurate diagnosis and effective surgical intervention.

Data Highlights

The patient was a 42-year-old woman with a history of progressive exertional dyspnea. Imaging studies revealed a 1.2-cm pseudoaneurysm associated with left ventricular dilation. Surgical intervention included aortic valve replacement and bovine pericardial patch repair, but the patient experienced recurrence of the pseudoaneurysm at 6 months and declined further surgery, ultimately leading to her death 8 months post-operation.

Key Findings

• A 42-year-old woman presented with progressive exertional dyspnea and was diagnosed with a right coronary sinus pseudoaneurysm.

• Transthoracic echocardiogram (TTE) revealed left ventricular dilation and a 1.2-cm pseudoaneurysm.

• Cardiac computed tomography angiography (CCTA) defined the three-dimensional extent of the pseudoaneurysm and its relationship to coronary arteries.

• Cardiovascular magnetic resonance (CMR) indicated myocardial involvement with T1 mapping showing patchy T1 elevation.

• The patient underwent aortic valve replacement and bovine pericardial patch repair but experienced pseudoaneurysm recurrence at 6 months.

• The patient declined reoperation and died 8 months post-surgery.

Clinical Implications

The case highlights the importance of multimodal imaging in diagnosing complex cardiac conditions.

Conclusion

This case presents a rare instance of aortic annular avulsion with associated pseudoaneurysms.

Related Resources & Content

1. 2025 ESC/EACTS Guidelines for the management of valvular heart disease

2. Pediatric Cardiology — Coronary Artery Anomaly Originating from the Incorrect Sinus in a 15-Year-Old Male Patient

3. Pediatric Cardiology — Utilization of 64-Slice CT Imaging to Prevent Misdiagnosis of Anomalous Left Main Coronary Artery Origin

4. Frontiers in Medicine — Case Report: Multimodal ultrasound diagnosis of traumatic right coronary sinus rupture combined with atrial septal tears

5. Frontiers in Cardiovascular Medicine — A Case Report of Iatrogenic Coronarocameral Fistula After Surgical Aortic Valve Replacement: Multimodality Diagnosis and Intravascular Ultrasound-Guided Left Main Intervention

6. 2025 ESC/EACTS Guidelines for the management of valvular heart disease

7. https://academic.oup.com/icvts/article/40/9/ivaf206/8251531

8. https://article.imrpress.com/journal/RCM/26/2/10.31083/RCM26005/595ffb45144380bc00af5d288240be29.pdf

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