Is it really ruptured sinus of valsalva? The crucial role of comprehensive transesophageal echocardiography in clinical decision-making

ventricular (LV) hypertrophy. The chest X‑ray except for cardiomegaly with LV apex was inconclusive. Upon TTE, patient was diagnosed with RSOVA draining into the left ventricle. Cardiac catheterization and angiography further showed‑normal coronaries, right coronary cusp (RCC) aneurysm with rupture into left ventricle causing severe regurgitation [Figure 1], normal left ventricle function, absence of any ventricular septal defect (VSD), no gradient across left ventricle and aorta and Qp/Qs = 1. Patient was scheduled for RSOVA repair with aortic valve repair/replacement.Following anesthetic induction, intraoperative multiplane, color Doppler, two‑dimensional and three‑dimensional (3D) ‑ TEE examination was performed (iE33

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