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Ruptured Sinus of Valsalva With Aorta–to–Right Atrial Fistula

Seamus Cullen, MB, BCh, BAO, MRCPI, DCh; ; Ian D. Sullivan, MB, BCh, FRACP

From the Cardiothoracic Unit, Great Ormond Street Hospital for Children NHS Trust, London, UK.

Correspondence to Dr Seamus Cullen, Cardiothoracic Unit, Great Ormond Street Hospital for Children NHS Trust, Great Ormond St, London WC1N 3JH, UK.

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.

View larger version (104K): [in this window] [in a new window]   Figure 1. Top left, Transesophageal transgastric view shows an aneurysm of the noncoronary sinus of Valsalva (arrow) with aneurysmal pouch extending into right atrium. Top right, Transgastric view with color flow mapping demonstrating flow from aorta into right atrium via ruptured sinus. Bottom left, Transesophageal longitudinal view with aneurysm extending into right atrium. Bottom right, Color flow mapping shows aorta–to–right atrial communication. RA indicates right atrium; RV, right ventricle; LA, left atrium; LV, left ventricle; and AO, aorta.

Footnotes

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, . . . [Full Text of this Article]

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