Background
Sinus of Valsalva aneurysm is a rare structural cardiac abnormality that may remain clinically silent until catastrophic complications occur.
Case Summary
A 51‑year‑old man was admitted following successful resuscitation from out‑of‑hospital cardiac arrest caused by ventricular fibrillation. The admission electrocardiogram showed no ST‑segment elevation, and transthoracic echocardiography demonstrated preserved biventricular systolic function. Emergency coronary angiography revealed severe narrowing of the left main coronary artery due to apparent external compression, with distal obliteration of the left anterior descending artery. Contrast‑enhanced computed tomography identified a giant aneurysm of the left sinus of Valsalva causing extrinsic left main compression. The patient underwent successful surgical repair with implantation of a Valsalva graft and recovered uneventfully.
Introduction
Sinus of Valsalva aneurysm (SVA) is an uncommon congenital or acquired cardiac condition resulting from weakness of the aortic sinus wall. While most aneurysms arise from the right or non‑coronary sinus, involvement of the left sinus is rare. Clinical presentation varies widely, ranging from incidental findings to life‑threatening complications such as rupture, heart failure, or coronary artery compression. Extrinsic compression of a coronary artery, particularly the left main coronary artery, represents a rare but malignant manifestation.
Case Presentation
A 51‑year‑old man was admitted after successful resuscitation from out‑of‑hospital cardiac arrest due to ventricular fibrillation. Return of spontaneous circulation was achieved after approximately 20 minutes of advanced life support. On admission, the patient was haemodynamically stable and in normal sinus rhythm.
The admission electrocardiogram showed no ST‑segment elevation. Transthoracic echocardiography demonstrated preserved left and right ventricular systolic function, without regional wall motion abnormalities, pericardial effusion, or signs of pulmonary embolism.
Laboratory investigations revealed markedly elevated D‑dimer levels and increased cardiac biomarkers, including troponin T and creatine kinase.
Given the unexplained cardiac arrest, emergency coronary angiography was performed. This revealed severe ostial and shaft narrowing of the left main coronary artery due to apparent external compression, with distal obliteration of the left anterior descending artery, while the circumflex and right coronary arteries appeared angiographically normal.
Subsequent contrast‑enhanced computed tomography demonstrated a giant aneurysm of the left sinus of Valsalva measuring approximately 3 × 4 cm with a thin aneurysmal wall, causing significant extrinsic compression of the left main coronary artery.
The patient underwent successful surgical repair with implantation of a 28‑mm Valsalva graft. The postoperative course was uneventful, and the patient completed cardiac rehabilitation without residual symptoms.
