{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T10:07:43Z","timestamp":1789380463235,"version":"build-2803163510"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Ruptured sinus of Valsalva (RSOV) is a rare cardiac lesion that may lead to a progressive right-sided cardiac overload and ultimately heart failure. Although surgery remains the primary intervention, transcatheter closure has emerged as a less invasive alternative in suitable patients. However, zero-fluoroscopy retrograde transcatheter closure of RSOV under echocardiography guidance alone is extremely rare.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 31-year-old man with a history of hypertension presented with symptoms of atypical chest pain and exertional dyspnea. Heart auscultation showed a grade III\/VI with a to-and-fro murmur. Pre-procedural transthoracic and transesophageal echocardiography (TTE and TEE) demonstrated a ruptured aneurysm from the right coronary cusp of the sinus of Valsalva with shunting into the right atrium. The defect measured 7\u2005mm at the aortic end and 6\u2005mm at the right atrial end, with a distance of 16.5\u2005mm from the right coronary ostium and no significant aortic regurgitation. The patient underwent a zero-fluoroscopy percutaneous closure using a retrograde transarterial approach under echocardiography guidance only. A Konar-MF VSD Occluder (8\/10\u2005mm) was successfully deployed. Post-procedural imaging showed a stable device position, with mild central residual shunt. No obstruction of the right coronary ostium or aortic regurgitation was observed. Final follow-up on TTE examination at 2 years revealed a complete closure without any residual flow.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case demonstrates the technical feasibility of a fully TEE-guided, zero fluoroscopy, retrograde transcatheter closure of RSOV in patients with favorable anatomy. This approach reduces radiation and contrast exposure without altering the short-term procedural success.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1906135","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T09:45:16Z","timestamp":1789379116000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Zero-fluoroscopy retrograde transcatheter closure of a ruptured Sinus of valsalva guided by transesophageal echocardiography"],"prefix":"10.3389","volume":"13","author":[{"given":"Damba Dwisepto Aulia","family":"Sakti","sequence":"first","affiliation":[{"name":"Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita","place":["Jakarta, 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