Giant Unruptured Sinus of Valsalva Aneurysm

Case Presentation. A 58-year-old Asian woman presented with substernal chest pressure made worse by swallowing. This discomfort had been present for 2 years and had recently become more severe and frequent.

Panel A. Computed tomographic scan of the chest demonstrated a very large, unruptured aneurysm of the aortic root.
Panel B. Echocardiographic image in the parasternal shortaxis view demonstrating the huge sinus of Valsalva aneurysm (A), the right coronary leaflet (R), left coronary cusp (L) and non-coronary cusp (N).
Panel C. Aortography demonstrated an 8 x 6 cm unruptured sinus of Valsalva aneurysm of the right coronary artery (RCA) cusp. Mildly enlarged and deformed non-coronary and left coronary cusps are also demonstrated. There was moderate aortic insufficiency present.
Elective aortic root replacement with coronary reimplantation was undertaken.

Panel D. Intraoperative photograph confirming size and adjacent structure of the aneurysm (A). Note the size relative to the left ventricle (LV).
The aortic root was replaced with a Medtronic aortic root bioprosthesis (Medtronic, Inc., Minneapolis, Minnesota). The left coronary artery ostium was reimplanted on the aortic graft. The stenotic ostium of the RCA was oversewn and the RCA bypassed with saphenous vein through the RCA. The patient tolerated the procedure well and was discharged home 4 days later.