Objective:

To report an exceptionally rare case of aortic annular avulsion with a right coronary sinus pseudoaneurysm and aorto-left ventricular communication, highlighting the role of multimodal imaging in diagnosis and surgical planning.

Approach:

• Case Presentation: A 42-year-old woman presented with progressive exertional dyspnea following a 4-month history of chest tightness. Multimodal imaging including TTE, CCTA, CMR, and TEE was performed, revealing a right coronary sinus pseudoaneurysm and a large interventricular septal dissecting aneurysm.

Key Findings:

• Multimodal imaging was essential for accurate diagnosis and surgical planning, revealing a right coronary sinus pseudoaneurysm and interventricular septal dissecting aneurysm.
• The patient had a favorable early postoperative course but experienced pseudoaneurysm recurrence at 6 months.
• The patient declined reoperation and died 8 months after the initial surgery.

Interpretation:

The case illustrates the complexity of diagnosing aortic annular avulsion with associated pathologies and the importance of comprehensive imaging for accurate diagnosis.

Limitations:

• The case is singular and may not represent broader patient populations.
• Long-term outcomes and effectiveness of imaging strategies in similar cases are not established.

Conclusion:

This case emphasizes the critical role of integrated multimodality imaging in managing rare cardiac conditions and the need for structured mid-term imaging surveillance.