Ruptured Sinus of Valsalva Aneurysm in a Patient with a Ventricular Septal Defect Who Dropped Out of Lifelong Medical Follow-up

Abstract

Ruptured sinus of Valsalva aneurysm (RSOVA) is a rare cardiac condition associated with high morbidity and mortality rates. We herein report a 35-year-old man with a history of ventricular septal defect (VSD). He had a history of interrupted hospital visits and presented to the emergency department with dyspnea, palpitations, and dizziness for a few days. Auscultation detected a continuous murmur. Transthoracic echocardiography followed by transesophageal echocardiography demonstrated RSOVA in the right ventricle with an aorto-right ventricular fistula. The fistula was resected, and the aneurysm was surgically repaired. The patient made a good recovery.

Keywords: continuous murmur; ruptured sinus of Valsalva aneurysm; ventricular septal defect.

Figure 1.

Transthoracic echocardiography (TTE). Parasternal long-axis views in systole (A) and diastole (B) demonstrated focal protrusion of the right coronary sinus with a continuous left-to-right flow on Doppler color-flow imaging. RV: right ventricle, LV: left ventricle, SOV: sinus of Valsalva, Ao: aorta

Figure 2.

A transesophageal echocardiogram (TEE). Mid-esophageal RV inflow-outflow view in systole (A) and diastole (B) demonstrated focal protrusion of the right coronary sinus with continuous left-to-RVOT on Doppler color-flow imaging. AoVO: aortic valve orifice, RVOT: right ventricular outflow tract

Figure 3.

Computed tomography demonstrated intravenous contrast in the communication between the aortic root and RVOT (arrow). RVOT: right ventricular outflow tract, Ao: aorta, SOV: sinus of Valsalva, LV: left ventricle

Figure 4.

A: VSD is demonstrated at surgery (asterisk). B: RSOVA is demonstrated at surgery (yellow arrow). C, D: The black star arrows point to the patch used to repair the RSOVA, and the yellow star arrow indicates the patch used to fix the VSD. AoVO: aortic valve orifice, PVO: pulmonary valve orifice