Introduction/Objective The sinus of Valsalva is the most proximal section of the ascending aorta near the aortic root. Sinus of Valsalva aneurysms (SOVA) is a rare congenital or acquired condition of the aortic root. Ruptured SOVA typically involves another chamber of the heart. Free wall rupture of the SOVA is normally associated with sudden death due to tamponade. We report a case of blunt trauma resulting in the rupture of the non-coronary sinuses of Valsalva, which was successfully repaired.

Case Presentation The patient is a 47-year-old male with a past medical history of left thoracotomy and sternotomy for penetrating trauma who recently sustained blunt chest trauma at work. The patient was transferred from an outside hospital due to concern for thoracic aortic injury with active extravasation into the pericardium. Upon arrival, the patient complained of a brief loss of consciousness, chest pain, and shortness of breath. On the primary survey, the patient required BiPAP and esmolol drip. Transthoracic echocardiogram (figure 1A) and chest CTA (figure 1B) revealed a rupture of the sinus of Valsalva. Figure 1A: The transthoracic echocardiograph reveals a rupture of the sinus of Valsalva. The rupture is near the aortic root's non-coronary cusp (NCC). Also visible are the right ventricle (RV), left ventricular outflow tract (LVOT), right coronary cusp (RCC), and ascending aorta. Figure 1B: Axial view of chest CT showing disruption of the non-coronary cusp (NCC) with contained posterior hematoma within the mediastinum. The left coronary cusp (LCC) and right coronary cusp (RCC) are visualized. The patient underwent a redo sternotomy, revealing a rupture of the left and non-coronary aortic root sinuses. He received a biological aortic root and valve replacement. After a prolonged hospital course, he was discharged home and resumed all normal activities upon outpatient follow-up.

Discussion A literature search did not identify any reports of long-term survival following emergency surgical intervention for traumatic, free rupture of the Sinuses of Valsalva. We identified reports of non-traumatic ruptures of the SOVA into the pericardium causing tamponade. The unique feature of this case was the acute traumatic cause of the rupture, the distinct CT and TTE findings, and the successful aortic valve replacement. The history of sternotomy for penetrating trauma possibly contributed to the patient’s survival.

Conclusion Traumatic free wall ruptured sinus of Valsalva into the mediastinum can show specific radiological findings; rapid surgical correction should ensue.