Echoes, Shadows, and Scans: A Multimodality Pursuit Unmasking a Peripartum Sinus of Valsalva Rupture

Sinus of Valsalva aneurysm rupture (SOVAR) is an uncommon but serious cause of heart failure. Peripartum presentation is exceedingly rare and may mimic more common conditions such as peripartum cardiomyopathy. Early diagnosis is critical, as outcomes depend on prompt recognition and intervention. Case Presentation: A 30-year-old woman presented two months postpartum with progressive dyspnea, orthopnea, leg edema, and intermittent chest discomfort. Initial work-up revealed elevated BNP, biventricular enlargement, and moderately reduced left ventricular ejection fraction. Transthoracic and transesophageal echocardiography revealed a mobile structure adjacent to the tricuspid valve and severe right heart dilation. Cardiac magnetic resonance (CMR) imaging confirmed a ruptured noncoronary sinus of Valsalva aneurysm extending into the right atrium, with a significant left-to-right shunt (Qp:Qs 2.7). Computed tomography angiography further delineated the defect and ruled out coronary artery disease. The patient responded well to diuretic and guideline-directed medical therapy and was referred for surgical repair. Discussion: This case highlights the diagnostic challenges of postpartum dyspnea and underscores the importance of a multimodality imaging strategy. CMR enabled definitive diagnosis, volumetric analysis, and accurate shunt quantification, proving instrumental in differentiating structural heart disease from peripartum cardiomyopathy. Conclusion: Peripartum SOVAR is a rare but treatable cause of heart failure. Multimodal imaging—including echocardiography, CT angiography, and CMR—is essential to identify structural lesions, characterize shunt physiology, and guide management in complex cases.