Discussion
A giant AAA is a rare disease which is defined as an aneurysm more than
10 cm in diameter 2. The AAA’s size, rapid expansion, and calcification
are associated with an increased risk of rupture3. To our knowledge, a
giant AAA associated with a ruptured sinus of Valsalva into the right
atrium has not been reported previously. Transthoracic echocardiography
is the first-line imaging modality in detecting proximal ascending
aortic structure. Computed tomography angiography and magnetic resonance
angiography have nowadays become commonly used imaging modalities in
confirming the diagnosis of AAA and precise its dimensions.
Intraoperative transesophageal echocardiography is a versatile
diagnostic and monitoring tool to assist with surgical decision-making
in the operating room4. In our case, transthoracic echocardiography and
computed tomography angiography failed to detect the rupture in the
sinus of the Valsalva aneurysm. Intraoperative transesophageal
echocardiography provides additional information to the surgical team
and assists in adjusting the surgical plan. Our case highlights that
multimodality imaging plays a paramount role in making a definite
diagnosis of a giant AAA associated with a ruptured sinus of Valsalva
into the right atrium.
Conflicts of interest: None declared.
Informed consent: Informed consent was given by the patient.
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