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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