Cardioembolic Stroke from Sinus of Valsalva Aneurysm Thrombosis: A Rare and Late Complication of Surgical Aortic Valve Replacement – A Case Report
Amar Kalidas, Hafez Golzarian, Sumon Khalique, Amna Janjua, Okechukwu N MgbemenaABSTRACT
Background
Acquired sinus of Valsalva aneurysm (SOVA) is a rare post-surgical complication that is often asymptomatic but can lead to various complications, including fistulas, heart failure, and rupture. In rare cases, blood stasis within the aneurysmal sac can also result in thromboembolic events.
Case Summary
We report a case of thrombosed SOVA diagnosed a decade after surgical aortic valve replacement. Despite lifelong anticoagulation with warfarin, the patient experienced multiple transient ischemic attacks culminating in a major ischemic stroke. Multimodal imaging revealed an acquired SOVA with interval resolution of a previously identified intraluminal thrombus. Fortunately, she achieved complete symptom resolution and underwent successful open valve-sparing root repair.
Discussion
This case highlights SOVA as an uncommon yet important and treatable post-surgical complication and etiology of cardioembolic stroke. It also underscores the potential for delayed clinical sequelae from acquired SOVA, even years after surgery. Finally, it emphasizes the value of multimodal imaging for timely diagnosis of such abnormalities.