Right Sinus of Valsalva Aneurysm with Rupture into the Interventricular Septum and into the Left Ventricle.

A 16-year-old black boy presented with complaints of shortness of breath, dyspnea at rest during the last month. Examination revealed a wide pulse pressure and a continuous murmur across the precordium. The transesophageal echocardiogram showed a ruptured aneurysm of the right sinus of valsalva. The sinus rupture dissected into the interventricular septum [Figure 1, blue arrow] and then into the left ventricular cavity [Figure 2, white arrow]. The patient underwent surgical correction of the defect successfully.

Figure 1

Transesophageal echocardiography showing rupture of the right sinus of valsalva into the interventricular septum

Figure 2

Transesophageal echocardiography showing rupture of right sinus of valsalva into the intenventricular septum and into the left ventricle

Aneurysm of the sinus of valsalva account for only 1% of congenital cardiac anomalies. Of this aneurysm, 70% arise from the right sinus of valsalva. Most of the remainder arises from the noncoronary sinus and <5% from the left coronary sinus. Unlike others populations, in Africa, the rupture into the interventricular septum is the most frequent complication of these aneurysms,[1] followed by rupture into the right chambers. However, the simultaneous rupture of sinus of valsalva aneurysm into the interventricular septum and the left ventricle is an extremely rare heart condition.