Ruptured aneurysm of aortic sinus of Valsalva into right ventricle

We report a patient with ruptured aneurysm of the aortic sinus of Valsalva into the right ventricle, whose heart murmur represented only a diastolic element without aortic regurgitation. Surgery revealed a small opening through myocardium of the ventricular septum without ventricular septal defect. During systole, the opening was constricted and presumably closed with myocardial contraction, and left-to-right shunt might have occurred only in diastole. This might lead to only a diastolic murmur.