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Ruptured Sinus of Valsalva Aneurysm With Aorto-Atrial Fistula Mimicking Tricuspid Valve Endocarditis
Mohammed El-Nayir1, Karldon Nwaezeapu1, Emmanuel Daniel1
1Department of Internal Medicine, Trinity Health Ann Arbor, Ypsilanti, Michigan, USA.
Background:
Sinus of Valsalva aneurysm (SOVA) is a rare cardiac anomaly that can lead to acute cardiovascular collapse if ruptured. Prompt diagnosis and surgical repair are vital for survival.
Case Summary:
A 26-year-old woman presented with right upper quadrant pain and nausea. Work-up revealed elevated inflammatory markers, congestive hepatopathy, severe aortic regurgitation, and a suspected tricuspid valve vegetation. Infectious studies were negative. Transesophageal echocardiography ultimately identified a ruptured SOVA with an aorto-right atrial fistula. She underwent successful surgical repair and made a full recovery.
Discussion:
Ruptured SOVA can mimic infective endocarditis and may be misdiagnosed without careful imaging. In this case, what was thought to be a vegetation was a ruptured aneurysm. Multimodality imaging played a key role in diagnosis, and early surgical repair was crucial.
Take-Home Messages:
Ruptured SOVA should be suspected in young patients with right heart failure and inconclusive infectious work-up. Early diagnosis ensures optimal outcomes.
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Aortic Regurgitation I: Introduction
Aortic Regurgitation II: Clinical Features and Diagnostic Tests
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