CTICasesRuptured Sinus of Valsalva Aneurysm with Anomalous Septal Course of Left Main Coronary Artery
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Imaging findings
CT shows an abnormal outpouching from the non-coronary sinus extending into the right atrium, consistent with a ruptured Sinus of Valsalva aneurysm. Cine sequences demonstrate two jets of shunting blood: one posteriorly towards the right atrium (throughout cardiac cycle) and another anteriorly (pronounced during diastole due to RV pressure release). Additionally, the left main coronary artery has an anomalous septal course, originating from the right coronary cusp, coursing into the septum, giving off a large septal branch, and then exiting to supply the circumflex and a "second LAD" territory. MRI confirms the two shunting jets.
Key takeaways
Sinus of Valsalva aneurysms are often congenital and can rupture into the right atrium, leading to heart failure. The presence of two shunting jets with different flow dynamics depending on cardiac cycle phase is notable. Concurrent anomalous coronary anatomy, specifically a septal course of the left main, is a rare additional finding.
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