Ruptured Sinus of Valsalva With Aorta–to–Right Atrial Fistula
A20-year-old man presented with a history of acute-onset left-sided chest pain that radiated to the left shoulder and arm. This was associated with breathlessness. He had undergone repair of a “high” perimembranous ventricular septal defect at 2 years of age at this hospital. Since that operation, serial clinical examinations had revealed no cardiac murmurs. On this occasion, a new continuous cardiac murmur was heard at the left sternal edge on auscultation. Transesophageal echocardiography was performed (Figure⇓). This demonstrated an aorta–to–right atrial fistula through a ruptured noncoronary sinus of Valsalva. This was confirmed at operation, and repair was undertaken. At 6-month follow-up, the patient remained well and asymptomatic.
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.
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