Isolated Saccular Pseudoaneurysm of Left Sinus of Valsalva Post Angioplasty: Role of Multimodal Imaging in Diagnosis and Management

The sinus of Valsalva pseudoaneurysm is an exceedingly uncommon disorder characterized by severe pathological dilatation of the aortic root sinus, resulting in an aberrant accumulation of blood inside a false lumen subsequent to an intimal rupture. Typically, it originates from the right or non-coronary sinus, while involvement of the left sinus of Valsalva is exceedingly rare. This syndrome may be either congenital or acquired as a result of infection, trauma, or during catheter-based percutaneous procedures or surgery. If untreated, life-threatening aorto-cavitary fistulae involving neighboring heart chambers may occur. We present here a rare case of a 67-year-old patient who acquired an iatrogenic isolated left coronary sinus pseudoaneurysm following percutaneous angioplasty. Multi-modal imaging was employed to ascertain the pathology and devise the surgical plan. Intra-operative transesophageal echocardiography directed the surgical approach and validated the sufficiency of the surgical repair.