Biventricular outflow obstruction in a patient with a large sinus of the Valsalva aneurysm

Aneurysms of the sinus of Valsalva are defined as an abnormal enlargement of any of the three aortic sinuses. Congenital and acquired forms have been recognized. The right coronary sinus is the most common affected sinus, followed by non-coronary and left coronary sinuses (1). The prevalence of this anomaly is 0.09% in the general population (2). Unruptured aneurysms of the sinus of Valsalva are usually asymptomatic. However, symptomatic cases have also been reported (1, 2). We report a rare case of aneurysm of the sinus of Valsalva that resulted in right ventricular outflow tract (RVOT) obstruction with concomitant sub-valvular aortic web, causing severe left ventricular outflow tract obstruction, which we believe has not been published previously.