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The diagnosis of sinus of Valsalva aneurysm is usually made when acute congestive heart failure occurs following a rupture of the aneurysm into the right ventricle or the right atrium. We report a rare case of unruptured right sinus of Valsalva aneurysm.
A 73 year old man was admitted to our hospital because of progressive dyspnoea on exertion. On examination his pulse was regular at 84 beats/min and blood pressure 150/46 mm Hg. To and fro murmur of Levine 2/6 grade was heard at the second right sternal border. ECG showed left ventricular hypertrophy with ST-T changes, and chest radiography showed moderate cardiomegaly (cardiothoracic ratio 0.74) and bilateral pleural effusion. Aortic regurgitation was thought to be the cause of his congestive heart failure. However, transoesophageal echocardiography (left) revealed a large aneurysmal change of the right sinus of Valsalva as well as severe aortic regurgitation. A protrusion of the aneurysm into the right ventricle appeared to obstruct blood flow to the outflow tract. A shunt flow was not detected. Intravenous digital subtraction angiography confirmed the diagnosis of unruptured right sinus of Valsalva aneurysm, demonstrating an impressive large filling defect within the right ventricle (right). (LA, left atrium; LV, left ventricle; SVA, sinus of Valsalva aneurysm; PA, pulmonary artery.)