Danger above: a classic case of an unruptured right sinus of Valsalva aneurysm.

A 78-year-old man with a medical history significant for hypertension, dyslipidaemia and obstructive sleep apnoea presented for evaluation of atypical chest pain and slowly progressive exertional dyspnoea. Cardiac auscultation revealed a diastolic murmur. Transthoracic echocardiography showed a right saccular aneurysm of the sinus of Valsalva (ASV) with a diameter of 51 mm and moderate aortic valve regurgitation (figure 1, videos 1 and 2). Cardiac electrocardiography-gated multidetector CT showed protrusion of the aneurysm into the right ventricular outflow tract (figure 2); three-dimensional reconstruction is also shown (figure 3). The patient was referred to surgery and preoperative coronary angiography showed minimal coronary atherosclerosis. Intraoperative transoesophageal echocardiography demonstrated significant aortic regurgitation (figure 4, videos 3 and 4). Surgical correction was achieved with bovine pericardial patch closure to the right sinus of Valsalva aneurysm and bioprosthetic aortic valve replacement. Figure 1 Transthoracic …