Noncoronary sinus of Valsalva aneurysm with rupture into the right atrium

Sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly, with autopsy-confirmed fatal cases remaining uncommon. This report presents a rare case of sudden death in a 13-year-old male adolescent caused by rupture of a noncoronary SVA into the right atrium, resulting in acute circulatory dysfunction, with vomiting as the only initial symptom. The cause of death was confirmed through comprehensive forensic autopsy, histological examination, and toxicological analysis. Additionally, a review of relevant autopsy case reports published in the past two decades on PubMed and Web of Science identified 13 cases of SVA-related mortality. We summarized the anatomical origin of aneurysms, gender distribution, clinical manifestations, rupture-associated fatal mechanisms, and pathological features observed in these cases. The findings indicated that in SVA-related fatal cases, the most common rupture sites were the right coronary sinus, left coronary sinus, and noncoronary sinus. The rupture typically occurred into the atrium or pericardium. Chest pain and vomiting were frequently reported as prodromal symptoms. Imaging techniques such as echocardiography and computed tomography were useful in aiding diagnosis. Cardiac pathology in these cases was often accompanied by additional abnormalities, including cardiomegaly, atherosclerosis, inflammation, or congenital defects. This report, in conjunction with the literature review, provides important reference material for forensic autopsy.