Unruptured aneurysm of sinus of Valsalva with right ventricular outflow tract obstruction

Aneurysm of the sinus of Valsalva (ASV) is a rare anomaly. It may be congenital or acquired basis. In pediatric patients, most are congenital in origin. It is frequently associated with other congenital disease, most frequently ventricular septal defect (VSD). Pathologically, this is due to the total absence of normal elastic fibers. Patients with ASV are generally asymptomatic unless aneurysm rupture occurs. Unruptured ASV with right ventricular outflow tract (RVOT) obstruction is very rare. Herein we describe an unusual ASV with RVOT obstruction associated with VSD in a 14-year-old boy. He had experienced heart failure and exertional dyspnea for 2 months. The diagnosis was made by echocardiography, angiography and surgery. After surgical repair of the VSD and resection of the ASV, dyspnea and heart failure were relieved. The patient remained well during the 3 years of follow-up.