Aneurysm of the sinus of Valsalva: its natural history

This case demonstrates that complications develop with aneurysm of the sinus of Valsalva. The aneurysm is diagnosed almost exclusively only after rupture. We feel that echocardiography provides a convenient means to follow cases of suspected aneurysms. A change in aortic root size may indicate imminent rupture. Fluttering of the anterior leaflet of the mitral valve would suggest aortic insufficiency, while an increase in right ventricular size coupled with paradoxical septal motion would strongly suggest a left-to-right shunt. Change in a murmur or in the aortic silhouette probably warrants cardiac catheterization. If rupture is suggested by clinical findings and corroborated by catheterization, surgery is indicated to prevent progressive cardiac failure.