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A 56-year-old woman presented with dyspnoea on exertion. Chest X-ray showed an ill-defined
opacity in right lower chest. Echocardiography, CECT thorax, CT and coronary angiography
showed a large unruptured aneurysm with organised thrombus, arising from the non-coronary
sinus of Valsalva with calcification around the communication and surrounding aorta
without any atrial or ventricular communication and a normal aortic valve, which was
compressing the right lung (Fig. 1 and Supplementary Figs. 1–3). The operative findings included dense pericardial adhesions
with a large unruptured aneurysm arising from the non-coronary sinus of Valsalva filled
with organised clots. The communication with the aortic root and the surrounding anterior
ascending aorta was calcified around the right coronary ostia. The aortic valve, left
coronary ostia and the distal ascending aorta were normal (Supplementary Fig. 4).
After partial excision of the aneurysmal sac, replacement of ascending aorta distal
to origin of left coronary ostia with a prosthetic graft and reimplantation of right
coronary button was done using cardiopulmonary bypass due to extensive aortic wall
calcification.
Fig. 1CT scan view showing an unruptured aneurysm with organised thrombus, arising from
the non-coronary sinus of Valsalva with calcification around the communication and
surrounding aorta. The aortic valve is normal.
