Rapid growth of right sinus Valsalva aneurysm dissecting into interventricular septum

A 45-year-old male presented with progressive dyspnea and bilateral leg swelling, which persisted since a week. Six months earlier, the patient underwent pacemaker implantation after experiencing syncope induced by a complete atrioventricular block. Initially, transthoracic echocardiography (TTE) revealed a large sac-like right sinus Valsalva aneurysm (SVA) dissecting into the interventricular septum (IVS) (Fig. 1, Panel a). We observed blood gushing into the aneurysm because of severe aortic regurgitation, which caused the aneurysm to bulge and extrude into the left ventricular outflow tract during diastole (Fig. 1, Panel b, Video 1). Furthermore, we simultaneously documented systolic and diastolic mitral regurgitation (Fig. 1, Panel c). However, we did not detect any shunt flow between the aneurysm and any chamber. Subsequent magnetic resonance imaging (Fig. 1, Panel d) scans confirmed these initial observations.