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A 57 year old woman underwent echocardiography following deep vein thrombosis of the left lower limb with consecutive pulmonary embolism. The exam incidentally revealed a giant congenital aneurysm of the non-coronary sinus of Valsalva with protrusion towards both atrial cavities, but without signs of rupture or penetration. There was low perfusion of the aneurysmal sack confined to diastole as its orifice was small and additionally covered by the non-coronary cusp during systole; no thrombus material could be detected inside the aneurysm. Mild aortic regurgitation resulted from slight detachment of the non-coronary commissure. Preoperative cardiac catheterisation confirmed the huge balloon-like aneurysm of the non-coronary sinus of Valsalva. The aneurysm ruptured while the patient was on the waiting list for elective operation and an emergency ligation had to be performed a few weeks after initial diagnosis. The postoperative course was uneventful and the patient is doing well.
Left and centre panels below show right anterior oblique-like transoesophageal echocardiographic view with the giant aneurysm of the non-coronary sinus of Valsalva arising posteriorly to the aortic root. Pronounced protrusion of the aneurysm towards the left atrium is visualised in this 101° echocardiographic plane. The right panel shows right anterior oblique angiographic projection of the left ventricle, the aortic root and the ascending aorta with the balloon-like aneurysm of the non-coronary sinus of Valsalva extending posteriorly and also to the right of the non-coronary sinus. Note the relatively faint filling of the aneurysmal sack with contrast dye as compared to the left ventricle and the aorta.