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European Journal of Echocardiography 2006 7(2):177-178; doi:10.1016/j.euje.2005.04.002
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Copyright © 2005, The European Society of Cardiology

Left sinus of Valsalva aneurysm with rupture into the right atrium

Omac Tufekcioglua,*, Iyad Fansab, Orhan Madena, Mustafa Hizarcic, Ali Kutsalc and Adnan Cobanogluc

aYuksek Ihtisas Hospital, Department of Cardiology, 06100 Sihhiye, Ankara, Turkey
bMustafa Kemal University, Tayfur Ata Sokmen Medical School, Department of Cardiovascular Surgery, Hatay, Turkey
cYuksek Ihtisas Hospital, Department of Cardiovascular Surgery, Ankara, Turkey

Received 10 January 2005; received in revised form 25 March 2005; accepted after revision 9 April 2005.

* Corresponding author. Tel.: +90 312 3061111; fax: +90 312 4671925. otufekcioglu{at}ttnet.net.tr


   Abstract
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 Abstract
 
Herein, we present the echocardiographic diagnosis of a case of left sinus of Valsalva aneurysm with rupture into the right atrium.

Keywords: Left sinus of Valsalva aneurysm; Right atrium; Echocardiography

A 24-year-old woman, with a history of continuous murmur at the left sternal border, was complaining of dyspnea and palpitation on exertion. The ECG showed incomplete right bundle branch block and mild cardiomegaly on chest roentgenogram. Transthoracic echocardiography revealed an aneurysm of the left sinus of Valsalva (ALSV) that had ruptured into the right atrium, with left to right shunting. The right atrium (RA) was mildly enlarged. A modified parasternal short axis view showed the entry point of the aneurysm in the left coronary sinus, and a tortuous tunnel (arrows in panel A) (Fig. 1). In the RA, there was a draining ‘wind-sock’ orifice (arrows in panel B). Continuous flow was observed in the aneurysm (panels C and D). Diagnosis was confirmed with cardiac catheterization. During surgery the opening of the aneurysm was identified in the left coronary sinus and localized between the separate ostiums of the left anterior descending and circumflex coronary arteries. The opening was closed with a Dacron patch and the draining orifice in the RA was sutured. The patient did well after surgery. Most aneurysms of sinus of Valsalva arise from the right or non-coronary sinus. Only 1% arise from the left coronary sinus and rupture into the RA is extremely unusual.


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  		Figure 1 Transthoracic echocardiography revealed a left sinus of Valsalva aneurysm with rupture into the right atrium. Ao, aorta; LA, left atrium; RA, right atrium; RV, right ventricle.

 

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This Article
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