Rupture of a Nonaneurysmal Left Sinus of Valsalva Into the Pericardium

Acute type A aortic syndrome involving a nonaneurysmal sinus of Valsalva (SOV) without predisposing factors is exceptionally rare. The contribution of remote blunt chest trauma (BCT) in delayed aortic root pathology and aortic regurgitation remains uncertain.

A 71-year-old patient presented with acute chest tightness and a large nontamponading pericardial effusion. Computed tomography angiography was inconclusive, but transesophageal echocardiography (TOE) identified rupture of a nonaneurysmal left SOV and left aortic cusp causing severe aortic regurgitation. Urgent surgical repair was successful. No clear etiology was identified, though a bicycle-related BCT 6 years earlier was considered contributory, albeit unproven.

This case highlights the rarity and diagnostic challenge of nonaneurysmal left SOV rupture without clear predisposing conditions.

Transesophageal echocardiography is essential when computed tomography angiography is inconclusive for acute type A aortic syndrome. After BCT, comprehensive cardiac evaluation and long-term follow-up may identify delayed cardiac complications, even in patients without prior cardiac disease.