Device dislodgement in ruptured sinus of Valsalva aneurysm: the case for early surgical conversion

Ruptured sinus of Valsalva aneurysm (RSVA) is a rare but potentially life-threatening cardiac anomaly. Although transcatheter closure (TCC) has gained popularity as a less invasive option, anatomical complexity may compromise its success and necessitate urgent surgical conversion. We present the case of a 57-year-old male with a bicuspid aortic valve and ruptured RSVA forming a fistulous connection to the right atrium. Initial management with TCC was attempted based on anatomical feasibility and hemodynamic stability. However, the occluder device became dislodged immediately after deployment, prompting emergent surgical intervention. A successful surgical repair was performed via a median sternotomy with a reverse-U aortotomy (Kırali incision), allowing complete device retrieval and dual-site closure of the fistula. The patient's postoperative course was uneventful, with no residual shunting or aneurysmal recurrence on follow-up. This case underscores the limitations of transcatheter techniques in anatomically complex RSVA and highlights the critical role of early surgical conversion in preventing catastrophic complications. Adequate anatomical assessment and readiness for surgical backup are essential when considering percutaneous options in such scenarios.