In this rare case report
of giant unruptured
sinus of Valsalva aneurysm (SOVA), a 17-year-old male presented with sudden onset syncope due to complete heart block (CHB). An emergency evaluation was done with the help
of transthoracic echocardiography, transesophageal echocardiography, and cardiac catheterization with support
of temporary pacemaker. The obvious distorting effects
of a giant SOVA dissecting into interventricular septum were CHB, significant regurgitation
of tricuspid and mitral valve, mild regurgitation aortic valve and biventricular dysfunction. The case was treated by repair
of SOVA and posterior mitral ring annuloplasty. CHB improved to
sinus rhythm on 11th day after surgery. On follow-up, tricuspid valve regurgitation improved to mild regurgitation and he continued to have mild aortic regurgitation.
<Learning objective: Sinus of Valsalva aneurysm (SOVA) may present with cardiac emergency without rupture. A giant unruptured SOVA competes for space with neighboring intra cardiac structures. The distorting effects are erosion into interventricular septum, complete heart block (CHB), valvular and ventricular dysfunction. Transthoracic and transesophageal echocardiography provide enough information for emergency surgery. Sometimes, evaluation may need cardiac catheterization and computed tomography. Immediate surgery saves life. CHB may improve on follow-up.>