Unruptured sinus of valsalva aneurysm (SOVA) are typically asymptomatic, and hence can be easily ignored. Ruptured sinus of valsalva aneurysm (RSOVA) usually protrude into the right atrium or ventricular. However, in this case, the RSOVA protruded into the space between the right atrium and the visceral pericardium leading to compression of the right proximal coronary artery. Very few such cases have been reported till date. We describe a case of ruptured right SOVA in a 61-year-old man with syncope and persistent hypotension. At the beginning, considered the markedly elevated troponin, acute myocardial infarction was considered. However, emergency coronary angiography unexpectedly revealed a large external mass compressed right coronary artery (RCA) resulting in severe proximal stenosis. Then, aorta computed tomography angiography (CTA) and urgent surgery confirmed that the ruptured right SOVA led to external compression of the right proximal coronary artery. Finally, ruptured right SOVA repair and RCA reconstruction were successfully performed, and the patient was discharged with no residual symptoms. It is very important to be vigilant about the existence of SOVA. RSOVA should be suspected in a patient presenting with acute hemodynamic compromise, and echocardiography should be immediately performed. Moreover, it is very important to achieve dynamic monitoring by using cardiac color ultrasound. Definitive diagnosis often requires cardiac catheterization, and an aortogram should be performed unless endocarditis is suspected.

中文翻译：

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瓦氏动脉瘤破裂窦表现为晕厥和低血压：一例报告

未破裂的瓦氏动脉瘤（SOVA）通常是无症状的，因此很容易被忽略。瓦氏动脉瘤（RSOVA）破裂窦通常伸入右心房或心室。然而，在这种情况下，RSOVA 突出到右心房和脏心包之间的空间，导致右冠状动脉近端受压。迄今为止，此类案件很少被报道。我们描述了一名患有晕厥和持续性低血压的 61 岁男性右侧 SOVA 破裂的病例。一开始，考虑到肌钙蛋白明显升高，考虑急性心肌梗死。然而，紧急冠状动脉造影意外地发现一个巨大的外部肿块压迫右冠状动脉 (RCA)，导致近端严重狭窄。然后，主动脉 CT 血管造影 (CTA) 和紧急手术证实，右侧 SOVA 破裂导致右侧冠状动脉近端受到外部压迫。最终成功进行右侧SOVA破裂修复和RCA重建，患者无残留症状出院。警惕 SOVA 的存在非常重要。出现急性血流动力学损害的患者应怀疑 RSOVA，应立即进行超声心动图检查。此外，利用心脏彩超实现动态监测非常重要。明确诊断通常需要心导管术，除非怀疑心内膜炎，否则应进行主动脉造影。