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A 42 year old man (not a drug abuser) diagnosed with a ruptured aneurysm of the sinus of Valsalva seven years ago was referred because of low grade fever of one week duration, fatigue, vomiting, and abdominal pain. His blood pressure was 115/45 mm Hg. A continuous machinery murmur (grade 3/6) was heard along his left sternal border. Six blood cultures grew methicillin sensitiveStaphylococcus aureus. Transoesophageal echocardiography using a multiplane probe identified an aneurysm of the non-coronary sinus of Valsalva, which appeared as a calcified, circular structure protruding into the right atrium. The aneurysm was ruptured and a 2 cm long vegetation attached to the lower edge of the fistula was seen (top). Colour Doppler showed a turbulent left to right shunt through the perforation (bottom). The aneurysm was resected and the defect closed with an autologous pericardial patch. The patient had an uneventful postoperative recovery, and one year later, was alive and asymptomatic. (LA, left atrium; RA, right atrium; Ao, aorta; T, tricuspid valve; RV, right ventricle.)
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