Aneurysm of the sinuses of Valsalva is a rare congenital lesion caused by the separation of the aortic wall media from the valve ring tissue, but can also be acquired in association with trauma, bacterial endocarditis, syphilis, or tuberculosis.1 Rupture of the aneurysm is the most frequent complication and causes clinical symptoms in adulthood.
Prior to the advent of Doppler, contrast, and two-dimensional echocardiography, sinus of Valsalva aneurysm posed a difficult diagnostic challenge and could be confused with patent ductus arteriosus (PDA), coronary arteriovenous fistula, or ventricle septum defect (VSD) combined with aortic regurgitation (AR) by the clinician. We report our experience in the precise diagnosis of a continuous signal to confirm the presence of a ruptured congenital sinus of Valsalva aneurysm complicated with congestive heart failure using real-time echocardiography. Transthoracic echocardiography has reduced the need for coronary contrast angiography and has become the principal diagnostic tool over the last decade.2