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Ji Zhang, Tianyu Li, Bo Zhang, Ruptured syphilitic left coronary sinus of Valsalva aneurysm, European Heart Journal - Cardiovascular Imaging, 2025;, jeaf065, https://doi.org/10.1093/ehjci/jeaf065
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Extract
A 36-year-old woman presented with 3-h of chest pain, with a heart rate of 105 bpm and blood pressure of 90/60 mmHg. Laboratory tests were positive for Treponema pallidum antibodies (394.52 S/CO). Cardiac CT angiography (CTA) showed a hyper-dense fluid collection in the pericardial cavity (CT value: 50 HU) and a cystic hypodense lesion along the left cardiac border, partially calcified, measuring 10.5 × 8.6 × 8 cm, causing rightward cardiac displacement (Panel A). The ascending aortic root was dilated (4.3 cm), and the left coronary sinus of Valsalva had conical dilation with contrast extravasation through a 0.24 cm defect into the cyst, which had a 0.6 cm fistulous tract to the left ventricle (Panels C–F). The diagnosis was a ruptured syphilitic left coronary sinus of Valsalva aneurysm, forming pericardial pseudoaneurysm and left ventricular fistula, with pericardial hemotoma and ascending aortic aneurysm. Emergency surgery with cardiopulmonary bypass included repair of the left ventricular fistula, a Bentall procedure, and coronary artery bypass grafting. Follow-up CTA 45 days later showed successful repair (Panels G–I).