Surgical repair of ruptured sinus of Valsalva aneurysm with aorto-mitral destruction

Sinus of Valsalva aneurysms are rare cardiac anomalies with life-threatening potential when ruptured. While most arise from the right coronary sinus and rupture into right-sided chambers, left-sided ruptures are exceptionally uncommon and surgically challenging. We report a 57-year-old male with multiple comorbidities and newly diagnosed stage 4 follicular lymphoma who presented with New York Heart Association class IV heart failure. Imaging revealed a large pseudoaneurysm of the left sinus of Valsalva with perforation into the left atrium and ventricle, disruption of the aorto-mitral curtain, and severe mitral regurgitation. A multidisciplinary team recommended surgery prior to chemotherapy. The operation included a mitral valve repair with autologous pericardial patch, reconstruction of the aorto-mitral curtain, aortic valve replacement, and ascending aortic replacement with a Dacron graft. Post-operatively, the patient developed tamponade, bacteraemia and required prolonged intensive care, but ultimately stabilized and proceeded with lymphoma therapy, and is currently doing well. This case highlights the rarity and complexity of left-sided sinus of Valsalva aneurysm rupture involving multiple cardiac structures. Definitive surgical repair remains the gold standard, and a multidisciplinary approach is essential in optimizing outcomes for high-risk patients with significant comorbidities.