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Case report: a rare case of left-sided sinus of Valsalva aneurysm with concomitant coronary artery fistula and carotid artery aneurysm

Title: Case report: a rare case of left-sided sinus of Valsalva aneurysm with concomitant coronary artery fistula and carotid artery aneurysm
Authors: Kemberi, Marsioleda; Jakaj, Gentjan; Stratton, Richard; Baker, Daryll; Wendler, Olaf
Contributors: Spadaccio, Cristiano; Papathanasiou, Maria; Oyebanji, Tunde; Ranganathan, Deepti
Source: European Heart Journal - Case Reports ; volume 9, issue 10 ; ISSN 2514-2119
Publisher Information: Oxford University Press (OUP)
Publication Year: 2025
Description: Background Sinus of Valsalva aneurysms (SVAs) are rare cardiac anomalies often occurring with co-existing cardiac lesions, such as ventricular septal defects and aortic regurgitation. While often asymptomatic, SVAs can lead to severe complications, including rupture, aortic regurgitation, and dissection. Carotid aneurysms are also uncommon and pose a significant stroke risk if left untreated. Case summary We report the case of a 56-year-old woman who initially presented with a pulsatile right neck mass and was diagnosed with a right internal carotid artery aneurysm. Subsequent imaging revealed a 45 mm left-sided sinus of Valsalva aneurysm (SVA) and a concomitant coronary artery fistula involving the right coronary artery. She underwent staged surgical management with a modified Bentall procedure and later excision of the carotid aneurysm. Post-operative recovery was uneventful. Genetic testing later confirmed a diagnosis of Marfan's syndrome. Discussion SVAs originating from the left coronary sinus are exceedingly rare, but their potential for fatal complications demands early intervention. This case demonstrates that surgical repair of the left SVA, associated coronary fistula, and carotid aneurysm is both safe and effective, and it reinforces the role of genetic testing in patients with atypical presentations of aneurysmal disease. Multimodal imaging and a multidisciplinary approach are essential in guiding treatment decisions in such unusual presentations.
Document Type: article in journal/newspaper
Language: English
DOI: 10.1093/ehjcr/ytaf508
DOI: 10.1093/ehjcr/ytaf508/64488802/ytaf508.pdf
Availability: https://doi.org/10.1093/ehjcr/ytaf508; https://academic.oup.com/ehjcr/advance-article-pdf/doi/10.1093/ehjcr/ytaf508/64488802/ytaf508.pdf; https://academic.oup.com/ehjcr/article-pdf/9/10/ytaf508/64488802/ytaf508.pdf
Rights: https://creativecommons.org/licenses/by/4.0/
Accession Number: edsbas.C7AB2F8C
Database: BASE