{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T09:13:01Z","timestamp":1776417181680,"version":"3.51.2"},"reference-count":8,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T00:00:00Z","timestamp":1773100800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Aortic regurgitation (AR) is usually caused by intrinsic cusp pathology or aortic root dilatation. Beat-to-beat variability in AR severity, sometimes accentuated by rhythm disturbances, is uncommon and may be overlooked without rhythm-aware, multimodality imaging across multiple cardiac cycles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>A 30-year-old woman with prior ventricular septal defect repair presented with recurrent palpitations and frequent ventricular premature contractions (PVCs). Transthoracic echocardiography identified a ruptured right sinus of Valsalva aneurysm with intermittent severe AR, more pronounced during premature beats. Three-dimensional transoesophageal echocardiography demonstrated a structurally intact right coronary cusp that was intermittently drawn into the rupture orifice during diastole, consistent with a suction-mediated functional mechanism producing beat-to-beat variation in regurgitation severity. Cardiac computed tomography confirmed rupture morphology and excluded aortic root dilatation. Valve-sparing surgical repair abolished cusp entrapment and restored leaflet coaptation, with mild residual AR on intraoperative assessment. At 2-year follow-up, transthoracic echocardiography showed stable mild AR without progression, and the patient remained asymptomatic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This case illustrates a rare functional mechanism of dynamic AR caused by suction-induced cusp entrapment in a ruptured sinus of Valsalva aneurysm and underscores the value of rhythm-aware, stepwise multimodality imaging to guide valve-sparing management when cusp morphology is preserved.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytag149","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T12:24:16Z","timestamp":1773059056000},"source":"Crossref","is-referenced-by-count":0,"title":["Dynamic aortic regurgitation caused by suction-induced right coronary cusp entrapment in a ruptured right sinus of Valsalva aneurysm: a case report"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-9159-5773","authenticated-orcid":false,"given":"Qingyan","family":"Ma","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Function Diagnostics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University , No. 106, Zhongshan Second Road, Guangzhou 510080 ,","place":["China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5012-1025","authenticated-orcid":false,"given":"Ying","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University , No. 106, Zhongshan Second Road, Guangzhou 510080 ,","place":["China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,3,10]]},"reference":[{"key":"2026041704173258200_ytag149-B1","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1093\/ejcts\/ezs450","article-title":"Surgery for ruptured sinus of Valsalva aneurysm: 25-year experience with 55 patients","volume":"43","author":"Sarikaya","year":"2013","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026041704173258200_ytag149-B2","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1016\/j.amjcard.2006.11.047","article-title":"Sinus of Valsalva aneurysms\u201347 years of a single center experience and systematic overview of published reports","volume":"99","author":"Moustafa","year":"2007","journal-title":"Am J Cardiol"},{"key":"2026041704173258200_ytag149-B3","doi-asserted-by":"crossref","first-page":"e1062","DOI":"10.4244\/EIJ-D-23-00840","article-title":"Aortic regurgitation: from mechanisms to management","volume":"20","author":"Baumbach","year":"2024","journal-title":"EuroIntervention"},{"key":"2026041704173258200_ytag149-B4","doi-asserted-by":"crossref","first-page":"1167","DOI":"10.1016\/j.echo.2024.08.009","article-title":"Noninvasive imaging for native aortic valve regurgitation","volume":"37","author":"Anand","year":"2024","journal-title":"J Am Soc Echocardiogr"},{"key":"2026041704173258200_ytag149-B5","doi-asserted-by":"crossref","first-page":"1953","DOI":"10.1016\/j.jacc.2023.08.051","article-title":"Imaging methods for evaluation of chronic aortic regurgitation in adults: JACC state-of-the-art review","volume":"82","author":"Ranard","year":"2023","journal-title":"J Am Coll Cardiol"},{"key":"2026041704173258200_ytag149-B6","doi-asserted-by":"crossref","first-page":"e171","DOI":"10.1093\/ehjci\/jeab253","article-title":"Multi-modality imaging assessment of native valvular regurgitation: an EACVI and ESC council of valvular heart disease position paper","volume":"23","author":"Lancellotti","year":"2022","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2026041704173258200_ytag149-B7","doi-asserted-by":"crossref","first-page":"e1159","DOI":"10.1161\/CIR.0000000000000503","article-title":"2017 AHA\/ACC focused update of the 2014 AHA\/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology\/American Heart Association task force on clinical practice guidelines","volume":"135","author":"Nishimura","year":"2017","journal-title":"Circulation"},{"key":"2026041704173258200_ytag149-B8","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1093\/eurheartj\/ehab395","article-title":"2021 ESC\/EACTS guidelines for the management of valvular heart disease","volume":"43","author":"Vahanian","year":"2022","journal-title":"Eur Heart J"}],"container-title":["European Heart Journal - 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