Rupture of sinus of Valsalva aneurysm into the right ventricle
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A young black woman presented with acute severe right ventricular and moderate left ventricular cardiac failure secondary to rupture of a sinus of Valsalva aneurysm originating from the right coronary sinus. The rupture into the right ventricle was accompanied by severe aortic valve insufficiency. The aortic valve showed congenital myxomatous degeneration with no evidence of infective endocarditis or syphilis. Right ventricular endomyocardial biopsy revealed no evidence of any specific cardiac disease such as amyloidosis. Successful closure of the fistula, together with aortic valve replacement and a De Vega tricuspid annuloplasty, was carried out. M-mode and two dimensional echocardiography delineated the fistula, as well as the most unusual finding of tricuspid valve fluttering, which persisted after operation. Slight insufficiency of the Bjork-Shiley aortic prosthesis was noted at postoperative cardiac catheterization. The patient was discharged from hospital asymptomatic and with no abnormal clinical features.