Ruptured Sinus of Valsalva Aneurysm

Sinus of Valsalva aneurysm is a rare condition that can cause acute heart failure once it develops a fistula. A previously healthy 28-year-old man without history of intravenous drug use initially presents with an acute onset of heart failure symptoms. Transthoracic echocardiogram transesophageal echocardiogram revealed an aorto-atrial fistula causing significant left-to-right shunting. Blood cultures were negative for any infectious process. The patient initially required critical care with inotropic support and aggressive diuresis before going to the operating room for definitive repair. Intraoperative findings were consistent with the right sinus of Valsalva windsock deformity. Fistula formation from a ruptured sinus of Valsalva aneurysm is a rare cause of acute heart failure in young adults. However, all other causes should be ruled out, including endocarditis. In the setting of young, previously healthy adults, ruptured sinus of Valsalva is a rare but silent cause of acute-onset heart failure.