Sinus of valsalva aneurysm with fistula to the right atrium presented as acute heart failure in a young man

Patient: Male, 23 Final Diagnosis: Sinus of valsalva aneurysm (SVA) Symptoms: Chest pain • low O2 saturation • short of breath Medication: — Clinical Procedure: — Specialty: Cardiology OBJECTIVE: Rare disease BACKGROUND: Sinus of valsalva aneurysm (SVA) is a rare cardiac anomaly. It may be congenital or acquired; a coexisting cardiac lesion might be present. Rupture of the aneurysm, where it usually occurs in the right atrium, can cause acute symptoms of heart failure. Echocardiography (particularly TEE) can provide all necessary diagnostic data for safe surgical treatment. Treatment of choice is surgery. CASE REPORT: A 23-year-old male, previously healthy, presented to the emergency room (ER) with shortness of breath for the last 10 hours after lifting a heavy object. The patient had central chest pain. His O2 sat was 88%. ECG showed ischemic changes. Diagnosis of AMI was made, but auscultation revealed a murmur followed by a TTE and TEE, which revealed a ruptured sinus of valsalva aneurysm. CONCLUSIONS: This case report highlights the superiority of TEE over TTE in diagnosis and in planning adequate surgical treatment for patients with ruptured SVA, as well as the importance of ultrasonographer experience in the diagnosis. The optimal management for a ruptured SVA is surgical repair, with an acceptably low operative risk and good long-term outcome.