https://orcid.org/0000-0001-9692-3974
A 67-year-old woman presented with a 1-year history of exertional dyspnoea and was diagnosed with third-degree atrioventricular block, leading to her admission for pacemaker implantation. Echocardiography upon admission revealed the presence of a functionally bicuspid aortic valve. Further evaluation with coronary computed tomography angiography demonstrated that this bicuspid aortic valve was associated with an isolated left Valsalva sinus, resulting in a lack of communication between the aortic lumen and the left Valsalva sinus (Panels A–C, asterisks). Notably, the left coronary artery, originating from this isolated sinus (Panel D, asterisks), was dysplastic, and a Vieussens’ arterial ring (Panels E and F, arrow) was identified, which supplied the left coronary artery and left Valsalva sinus from the right coronary artery (see Supplementary data online, Movies S1 and S2). The patient underwent successful permanent pacemaker implantation, with favourable post-operative recovery. Despite the complete isolation of the left Valsalva sinus, the presence of Vieussens’ arterial ring prevented myocardial ischaemia, obviating the need for additional intervention. At a 3-month follow-up, the patient reported no significant symptoms.
A 67-year-old woman diagnosed with functionally bicuspid aortic valve accompanied by isolation of the left Valsalva sinus. (A–C) Panel A represents computed tomography virtual endoscopy images, while B and C show multi-planar reconstructions with maximum density projection images. The left Valsalva sinus (asterisks) is underdeveloped and does not communicate with the aortic lumen. (D) Panel D displays multi-planar reconstructions with maximum density projection images, revealing the connection of the left coronary artery to the left Valsalva sinus (asterisks). (E–F) These are volume rendering images where Vieussens’ arterial ring is visible (arrow).
Supplementary data are available at European Heart Journal online.
All authors declare no disclosure of interest for this contribution.
No data were generated or analysed for or in support of this paper.
