A Case of Ruptured Giant Sinus of Valsalva Aneurysm Into the Right Ventricle in a Patient With Both Atrial and...

Sinus of Valsalva aneurysm (SOVA) is a rare cardiac defect. In most cases, SOVA presents as an incidental finding during cardiac imaging. A dreadful complication of SOVA is spontaneous rupture, most commonly occurring into the right side of the heart resulting in an abrupt or insidiously progressive congestive heart failure. Ruptured SOVA is associated with poor prognosis with high mortality unless timely surgical intervention is deemed. We present a 23-year-old female who presented with a continuous heart murmur and exertional dyspnea. Transesophageal echocardiogram showed a ruptured 1.8 cm sinus of Valsalva aneurysm of the non-coronary cusp to the right ventricle, which resulted in a significant left-to-right shunt and pulmonary hypertension. Associated cardiac defects included ostium secundum atrial septal defect, peri-membranous ventricular septal defect, and moderate aortic and mitral valve insufficiency. The patient underwent successful surgical correction with significant resolution of the shunt and normalization of the pulmonary pressure. Despite being rare, SOVA can rupture spontaneously, resulting in decompensated heart failure. SOVA should be considered in the differential diagnosis of a continuous heart murmur. Early recognition and timely surgical intervention are pivotal in these cases to prevent further clinical deterioration or even death. LEARNING POINTS: Sinus of Valsalva aneurysms (SOVA) are usually silent until acute rupture. Rupture most commonly occurs into either the right ventricle or right atrium. A new continuous murmur is the most striking physical finding; it is always significant and must prompt urgent echocardiography to facilitate timely diagnosis and treatment. Ruptured SOVA has a poor prognosis with high mortality unless timely surgical intervention is deemed.