case_images: PMC8695605_01
case_images: Two-dimensional transthoracic echocardiographic images. (A) Long-axis view of the left ventricle showing an echo-lucent cavity in the left-ventricular myocardium with abnormal blood flow on color Doppler (arrow). (B) Short-axis view at the MV (mitral valve) level also showing the echo-lucent cavity with partitions in the left-ventricular myocardium and abnormal blood flow on color Doppler. AO, aorta; LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle; RVOT, right ventricular outflow tract.
case_images: fcvm-08-753627-g0001.jpg
case_images: PMC8695605_01_fcvm-08-753627-g0001.jpg
case_images: F1
case_images: An echocardiogram revealed a left SVA that ruptured into the left-ventricular myocardium, forming an echo-lucent cavity (Figure 1).
case_images: (A,B) CT angiogram images showing the anatomical profile of IPA (white arrow) and perforation (black arrow). (C,D) CMR LGE images showing the high signal intensity of the IPA with a distal low signal intensity ( ), and a linear high signal intensity (white arrow) of the IPA wall and partitions. LCS, left coronary sinus.
case_images: fcvm-08-753627-g0002.jpg
case_images: PMC8695605_01_fcvm-08-753627-g0002.jpg
case_images: F2
case_images: Furthermore, CT angiograms better captured a large, left-ventricular, IPA arising from a small perforation in the left SVA (Figures 2A,B). With CMR examination, late gadolinium enhancement (LGE) clearly demonstrated the left-ventricular IPA with distal thrombus and a linear enhancement of the IPA wall, compatible with myocardial fibrosis (Figures 2C,D).
case_images: Post-operation two-dimensional transthoracic echocardiographic images. (A) Short-axis view at the aortic valve level showing the perforation of the left sinus of Valsalva repair and (B) non-standard short-axis view showing the cessation of abnormal blood flow on color Doppler.
case_images: fcvm-08-753627-g0003.jpg
case_images: PMC8695605_01_fcvm-08-753627-g0003.jpg
case_images: F3
case_images: Three weeks after surgery, a follow-up echocardiogram demonstrated the cessation of the abnormal blood flow in the left sinus of Valsalva (Figure 3).