Embolic Stroke Due to a Large Noncoronary Sinus of Valsalva Aneurysm: A Multimodality Imaging Diagnosis.

Background: A sinus of Valsalva aneurysm (SoVA) is a rare cardiac condition caused by the dilation of a coronary sinus. If untreated, it can commonly lead to valvular dysfunction, arrhythmias, or rupture.

Case Summary: A 71-year-old patient with hypertension and hyperlipidemia presented with an embolic stroke. Multimodality imaging revealed a large, 7.0 cm × 5.6 cm SoVA originating from the noncoronary sinus and causing nearly complete obstruction of the left atrium. The aneurysm was surgically repaired, and the patient made a full recovery.

Discussion: In rare cases, a stroke may be the initial presentation of a SoVA. The probable cause of the patient's stroke was attributed to thrombus formation within the SoVA that embolized.

Take-home Messages: This case emphasizes the importance of multimodality imaging for the diagnosis of a SoVA and for planning surgical repair. Additionally, clinicians should consider a SoVA in the differential diagnosis for a patient presenting with a stroke.