Sinus of Valsalva Aneurysm

BACKGROUND: Sinus of Valsalva aneurysm (SOVA) is an infrequent condition commonly affecting the right coronary sinus. It is typically asymptomatic unless it compresses or ruptures into nearby structures. CASE SUMMARY: A 52-year-old man presented to the emergency department with clinical features of heart failure. Transthoracic echocardiography revealed a large SOVA with associated aortic regurgitation (AR), right ventricular outflow tract obstruction (RVOTo), and biventricular dysfunction. Given concern for impending rupture and hemodynamic compromise, the patient was transferred to a tertiary center with a dedicated aortic team for surgical repair. DISCUSSION: This is a case of a right saccular SOVA complicated by severe AR, RVOTo, and biventricular failure. Multimodality imaging is needed to define its anatomic extent and functional effect on neighboring structures. Surgical repair is preferred. TAKE-HOME MESSAGES: Unruptured giant SOVA can cause severe AR and RVOTo, leading to acute heart failure and mimicking myocardial infarction. Multimodality imaging and early referral to a specialized centers are critical for timely surgical management.