Figure 1 A-C, parasternal long axis and short axis view revealed a cystic cavity, located in the interventricular septal extending from the basal anteroseptum to anterior wall of the left ventricle, within it, a string-like echo is visible. D-F, color doppler and pulse wave doppler revealed that the cystic cavity communicated with aortic root aneurysm through the orifice (as the arrow indicates), and bidirectional blood flow was visible at the orifice.(LA, left atrium; LV, left ventricle; AO, aorta; PS, pseudoaneurysm; IVS, interventricular septal)
Computer tomography angiogram (CTA)(Figure 2, Movie S6) revealed that the patient had bicuspid aortic valve, two coronary sinus, and large aortic root pseudoaneurysm caused by ruptured anterior Sinus of Valsalva (SOV) aneurysm, with a diameter of 75x74x45mm and the neck about was 14mm, which dissecting into IVS. A subsequent coronary angiogram (Figure 3) demonstrated the main trunk and the branch of left coronary artery was clear with no stenosis, the right coronary artery showed slightly stenosis. Therefore, ventricular septal rupture due to acute myocardial infarction was not considered.