Ruptured Sinus of Valsalva Aneurysm During Covid-19 Pandemic : Case Series of Three Misdiagnosed Cases Rescued by Eras Guided Device Closure Procedure.

Background :Sinus of valsalva aneurysms (SVAs) are thin walled saccular outpouchings in the coronary sinus. SVAs usually rupture in the 3rd or 4th decade of life into right heart chambers to form aorto-cardiac stula. Misdiagnosis or delayed diagnosis of RSOV occurred due to prevailing Covid-19 like symptoms.Transthoracic Echocardiography (TTE) & Transesophageal Echocardiography (TEE) acted as rescue tools for diagnosing missed RSOV. RSOV necessitates emergent treatment. RSOV Device Closure has become rst line management. Furthermore, performing complex open heart surgeries during Covid 19 pandemic had become challenging. Application of Enhanced Recovery After Surgery (ERAS) protocol for device closure procedures made it possible to do these cases successfully without ICCU requirement. In this case Cases : series, we report three such cases of RSOV treated with ERAS guided device closure during Covid-19 Pandemic. These cases were initially misdiagnosed as Covid-19. This case series highlights the importance of TTE, TEE and ERAS in the successful outcome of RSOV patients. Conclusion : RSOV presenting with complications during Covid-19 pandemic, prompt diagnosis with echocardiography and treatment with device closure under multimodal imaging and adherence to ERAS protocol is benecial in limited ICCU scenarios.