Sinus of Valsalva Aneurysm With Rupture Into the Interventricular Septum and Left Ventricular Cavity
A23-year-old Haitian man presented with complaints of shortness of breath, dyspnea on exertion, and occasional palpitations. Examination revealed a wide pulse pressure and a continuous murmur across the precordium. The echocardiogram showed a ruptured aneurysm of the right sinus of Valsalva (Figure 1⇓). The sinus rupture dissected into the interventricular septum and then ruptured into the left ventricular cavity (Figures 2⇓ and 3⇓). No operative intervention was undertaken.
Aneurysms of the sinus of Valsalva account for only 1% of congenital cardiac anomalies. Of these aneurysms, 70% arise from the right sinus of Valsalva. Most of the remainder arise from the noncoronary sinus, and <5% from the left coronary sinus. Complications of sinus of Valsalva aneurysms include aortic insufficiency, coronary artery flow compromise, arrhythmia, and rupture. Most commonly, rupture occurs from the right coronary sinus into the right ventricle or right atrium. However, rupture may also occur into the pericardium, the pleural space, or the left heart chambers. Dissection of a ruptured sinus of Valsalva aneurysm into the interventricular septum has been reported only rarely. This is the only case in which 2D and color Doppler imaging demonstrate rupture of the right coronary sinus, with dissection into the interventricular septum, and rupture into the left ventricular cavity.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
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