Giant coronary sinus of Valsalva aneurysm.

A 29-year-old female was admitted to our hospital with nonspecific chest pain and dyspnea. Physical examination revealed systolic murmur. Laboratory findings were unremarkable. Transthoracic echocar-diography revealed a cystic mass adjacent to the right atrium and ascending aorta that was believed to be a large aneurysm of right

coronary artery (RCA). Coronary computed tomography angiography (CTA) showed a relatively thin neck, bilobed, and giant aneurysm originating from the anterior right side of sinus of Valsalva, which measured 9 × 5 cm in diameter. There was eccentric calcification on the aneurysm wall. The aneurysm impressed the right ventricle and atrium and minimally displaced RCA (Fig. 1). These findings were confirmed with the catheter angiography (Fig. 2).

Figure 1

a-f. (a) Enlargement of the right hilum (arrow). (b) Axial CTA image shows SVA (*) and wall calcification (arrow). (c) Displaced RCA. (d) Sagittal and (e) coronal images show SVA with the adjacent structures and aneurysm neck (arrow head). (f) 3-D-CTA image shows orientation of the SVA

AA - ascending aorta; LA - left atrium; LV - left ventricle; PA - pulmonary artery; RAA - right atrial appendage

Figure 2

a-d. (a) Aortic angiography shows an aneurysm neck (arrow) and first sac (*). (b) Double sac (*) and aneurysm wall calcification (arrow). (c) Giant SVA (*). (d) Displaced RCA (arrow)

Sinus of Valsalva Aneurysm (SVA) is a rare entity that is most frequently observed in the right sinus. Associated cardiac anomalies are observed in most cases such as ventricular septal defect. It is usually asymptomatic if unruptured. In cases with ruptured SVA, fatal complications can be observed. Endovascular or open surgery is the choice of treatment.