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(Circulation. 1999;100:1843-1844.)
© 1999 American Heart Association, Inc.

Images in Cardiovascular Medicine

Sinus of Valsalva Aneurysm With Rupture Into the Interventricular Septum and Left Ventricular Cavity

T. Wells, MD; B. Byrd, MD; D. Neirste, MD; C. Fleurelus, MD

From the Department of Cardiology, Vanderbilt University Medical Center, Nashville, Tenn.

Correspondence to Tim Wells, MD, Department of Cardiology, 315 MRB II, Vanderbilt University Medical Center, Nashville, TN 37232-6300.

	Introduction

 
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.

View larger version (46K): [in this window] [in a new window]   Figure 1. A, Parasternal short-axis view of aortic valve (Aov) shows aneurysmal cavity (An) arising from right sinus of Valsalva. B, In same view, color Doppler shows flow from ruptured right sinus of Valsalva into aneurysmal cavity. RV indicates right ventricle; PA, pulmonary artery.

View larger version (54K): [in this window] [in a new window]   Figure 2. Parasternal short-axis view of left ventricle (LV) shows ruptured sinus of Valsalva aneurysm (A) dissecting into interventricular septum.

View larger version (57K): [in this window] [in a new window]   Figure 3. Apical 4-chamber view shows turbulent diastolic color flow through sinus of Valsalva aneurysm (A), which has dissected into interventricular septum and then back into left ventricle.

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 . . . [Full Text of this Article]