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.