Spontaneous Coronary Artery Dissection Involving the Sinus of Valsalva Mimicking Aortic Dissection: A Case Report and Surgical Perspective

Background: Spontaneous coronary artery dissection (SCAD) is a rare, non-atherosclerotic cause of acute coronary syndrome, typically confined to the coronary arteries and managed conservatively. Case: We report a unique case of a 45-year-old man who presented with chest pain and syncope. Initial electrocardiography revealed ST-segment elevation, and imaging suggested aortic dissection. Emergency surgery revealed a hematoma in the sinus of Valsalva compressing the right coronary artery (RCA) ostium, caused by a SCAD extending beyond the coronary artery. The affected segment was resected, and coronary artery bypass grafting was performed. To our knowledge, this is the first reported case of SCAD extending into the sinus of Valsalva, mimicking an ascending aortic dissection. Although the angiographic appearance resembled type 1 SCAD, the anatomical pattern challenges existing classification. Conclusions: This case highlights the need for heightened awareness of atypical SCAD presentations, consideration of conservative management when appropriate, and the importance of interdisciplinary collaboration in diagnosis and surgical planning.