engleski

Sinus of Valsalva rupture in patient with congenital ventricular septal defect

A 19-year-old man with a congenital perimembranous ventricular septal defect (VSD) was referred to echocardiography because of a new onset thrill over the left sternal border. Also, according to patient’s medical records, a continuous murmur corresponding with VSD was enhanced from previously registered grade 3/6 to grade 5/6 registered at the time of presentation. Also, a previously described continuous murmur corresponding with VSD was enhanced from grade 3/6 to grade 5/6 registered at the time of presentation. Also, a previously described continuous murmur grade 3/6 corresponding with VSD was enhanced to grade 5/6 registered at the time of presentation. Echocardiography demonstrated a hyperdynamic left ventricular function and a perimembranous VSD and a ruptured right sinus of Valsalva (SVA) occurred at very similar locations, one just below the aortic valve and the other one just above it (Figures 1 A, B). Color and continuous-wave (CW) Doppler (Figure 2 A, B) revealed two overlapping left-to-right flows, with very similar peak velocities (about 6 m/s) and peak pressure gradients (about 140 mmHg). Closure of the VSD and repair of ruptured SVA by a pericardial patch was done. The majority of SVA are congenital in origin, due to a defect in aortic media, and in 30-60% patients may be associated with other congenital anomalies, the most common suprasternal type of VSD.1 SVA rupture can result in sudden death as a consequence of the acute onset of congestive heart failure, arrhythmia, cardiac tamponade, or ischemia.1 However, it may present with minimal symptoms.1 Therefore, the appearance of thrill in patients with congenital VSD is highly suggestive for SVA rupture. Also, our case suggests that in cases with a perimembraneous VSD and ruptured SVA occurred at very similar location, CW Doppler with characteristic left-to-right flows overlap in time and location could be helpful in rapid and clear diagnosis of the mentioned defects.

ventricular septal defec; echocardiography; sinus of Valsalva

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