The M-mode and two dimensional echocardiographic features are described of a patient with rupture of a sinus of Valsalva aneurysm into the right atrium. A clear echo-free zone arising from the tip of the aneurysm is visualised in the right atrium in diastole by peripheral injection of echocardiographic contrast material. At surgery a fistula was seen between the non-coronary cusp and the right atrium.
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