Right aortic sinus of Valsalva-to-right ventricle fistula complicating bacterial endocarditis of membranous ventricular septal defect: evaluation by two-dimensional, color flow, and Doppler echocardiography.

Rupture of the aortic sinus of Valsalva into the right ventricle is a rare complication of bacterial endocarditis. The majority of previous cases have been reported in patients with aortic valve endocarditis. This report describes this complication in association with infective endocarditis of a congenital membranous ventricular septal defect. Color flow imaging showed a mosaic-colored continuous flow signal from the right aortic sinus to the right ventricle. Continuous wave Doppler interrogation showed high-velocity systolic and diastolic flow signals due to continuous left-to-right shunt from the aorta to the right ventricle. The left-to-right shunt through a restrictive membranous ventricle septal defect was visualized as a mosaic-colored high-velocity systolic flow signal. These echocardiographic-Doppler findings permitted surgical correction of these defects without cardiac catheterization.