We report a rare case of interventricular septal dissecting aneurysm, that resulting from ruptured sinus of Valsalva aneurysm and paravalvular aortic root pseudoaneurysm. A 60-year-old man presented with chest pain and palpitation, the diagnosis was confirmed using multimodality imaging, including transthoracic echocardiography, computer tomography angiogram and coronary angiogram. The patient underwent the modified Cabrol procedure, repaired ruptured sinus of Valsalva aneurysm and closured the communication of the pseudoaneurysm in the department of cardiac surgery. In this case report, we provide information for clinicians diagnostic thought, and highlight the role of multimodality cardiac imaging.

Background: Cardiovascular impairment is an important complication of end-stage renal disease (ESRD) undergoing hemodialysis (HD) therapy. Left atrial (LA) deformation is closely related to left ventricular (LV) filling pressure and dysfunction, but quantification of LA dysfunction remains a challenge. The purpose of this study was to evaluate the LA function in ESRD patients using four-dimensional(4D) auto left atrial quantification(4D-LAQ). Methods: Thirty-seven ESRD patients (aged 51.68±15.98 years; 43% male) on HD and 34 healthy individuals (aged 42.03±11.50 years; 38% male) were enrolled in the study. All participants underwent conventional echocardiographic examinations and 4D-LAQ. The measurements of LA dimension, volume, emptying fraction, and longitudinal/circumferential strain parameters during triphasic were obtained from the LV long axis and apical 4-chamber views, which were taken offline using software (GE EchoPac 203). Results: In patients with ESRD, LA dimension and volume were higher than the healthy group, while the LASr (22.54±6.14 vs 33.74±5.07; p<0.05), LAScd (-12.54±5.83 vs -20.03±5.21;p<0.05), LASct (-10.00±4.93 vs -13.56±5.17;p<0.05 ), LASr-c (28.00±6.61 vs 35.29±7.24;p<0.05), and LAScd-c (-13.27±5.58 vs -18.47±8.65; p<0.05) were significantly lower. Furthermore, a good positive correlation was observed between the LAEF, LASr, and LAScd-c values and LV filling pressure, which reflect diastolic dysfunction. Conclusion: We demonstrated that the LA strain in dialysis patients was impaired before the occurrence of LA dilation. LA strain is more sensitive than traditional echocardiographic parameters, and LASr and LAScd-c may be useful to detect early myocardial involvement.