Unruptured sinus of Valsalva aneurysms - Multimodality imaging correlation helps determine indications and approaches for repair.

Despite conventional advice to watch-and-wait, unruptured sinus of Valsalva aneurysms (SOVA) of the non-coronary sinus may produce symptoms that prompt corrective surgery early. A case of a 51-year-old man is illustrated. He presented with shortness of breath and on and off chest pains, was noted to have a large SOVA of non-coronary sinus (NCC), compressing the left atrium with risk of systemic embolism due to presence of spontaneous echocardiography contrast with early thrombus formation. Coronary angiogram, computed tomography of the aorta and 3D echocardiography demonstrated anatomic and physiological correlations. These helped guide corrective surgery. No perioperative complications were encountered, and the patient was symptomatically better following surgery. Multi-modality imaging was crucial to understand the approach and the need for early repair of the SOVA of NCC successfully. Learning objectives: 1)Unruptured sinus of Valsalva aneurysms of non-coronary sinus can cause substantial clinical risks to patients, as identifiable with multi-modality imaging.2)Early surgical repair guided by imaging, with preservation of aortic valve anatomy appears a reasonable strategy in such patients.