Interatrial rupture of a non-coronary sinus of Valsalva aneurysm: a rare presentation of a rare disorder

A 65-year-old male was referred to our team after the incidental finding of a large non-coronary sinus of Valsalva aneurysm on computed tomography (CT)-scan of the thorax. Further imaging with transesophageal echocardiography (TOE) excluded intracardiac shunting. Unusually, the aneurysm had ruptured into the interatrial septum and was seen to be compressing both atria. At operative intervention, a 20 mm defect which had replaced the non-coronary sinus was repaired using a patch graft. An aneurysm of an aortic sinus is a rare disorder, and a rupture of a non-coronary sinus typically results in the formation of a fistulous tract in the right atrium. These images highlight an unusual case of a non-coronary sinus of Valsalva aneurysm which ruptured into the interatrial septum (IAS), and demonstrate the benefit of multi-modality cardiac imaging in guiding surgical repair.