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Updated: Jan 22, 2026

Murine Model of Central Venous Stenosis using Aortocaval Fistula with an Outflow Stenosis
Published on: July 11, 2019
Ruptured Sinus of Valsalva Aneurysm With 2 Simultaneous Fistulas to the Left Ventricular Outflow Tract
Ryoto Mitsumizo1, Ryuichi Matsukawa2, Takayuki Uchida3
1Clinical Training Center, Aso Iizuka Hospital, Iizuka, Japan.
Background:
Sinus of Valsalva aneurysm (SOVA) rupture usually forms fistulas into right heart chambers; left-sided ruptures are exceedingly rare.
Case Summary:
A 73-year-old woman presented for evaluation of ST-segment depression in V5 and V6 and moderate aortic regurgitation. Imaging revealed a noncoronary cusp-origin SOVA with 2 simultaneous fistulas into the left ventricular outflow tract. She remained asymptomatic with stable hemodynamics, allowing elective surgical repair with patch closure, direct suture, and bioprosthetic valve replacement.
Discussion:
The left-to-left shunt decompressed the aneurysmal sac, preventing acute heart failure. Unlike typical left-to-right ruptures, these favorable flow dynamics allowed safe delayed intervention. Histopathological examination suggested age-related degeneration rather than congenital or inflammatory etiology.
Take-Home Messages:
This is the first reported case of a noncoronary cusp SOVA rupturing into 2 left ventricular outflow tract fistulas. Careful hemodynamic assessment is crucial, as select patients may benefit from elective rather than urgent repair.
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