Key result
Single-stage surgical repair achieves complete recovery in ruptured sinus aneurysm with concurrent VSD.
Why the study?
Sinus of Valsalva aneurysm rupture with concurrent perimembranous ventricular septal defect presents diagnostic and surgical challenges that require clarification.
Case Report (n=1)
Color Doppler echocardiography is critical for evaluating dual-shunt physiology when CT angiography is inconclusive, and single-stage surgical repair is highly effective for multilesion ruptured sinus of Valsalva presentations.
Alerts clinicians to sinus of Valsalva rupture in pmVSD with acute HF; extends anatomic variants but leaves optimal management open.
BACKGROUND: Sinus of Valsalva aneurysm is a rare anomaly that, when ruptured, causes high-flow shunts and rapid-onset heart failure. We report a rare anatomical variant of right coronary sinus aneurysm rupturing into the right atrium with a concurrent perimembranous ventricular septal defect (pmVSD). CASE SUMMARY: A 16-year-old male with known pmVSD presented with progressive NYHA functional class III dyspnea for 15 days. Volume overload was initially misattributed to ventricular septal defect progression. However, transthoracic echocardiography demonstrated a restrictive pmVSD (3.4 mm opening, peak gradient 60 mm Hg), elevated right ventricular systolic pressure (76 mm Hg) as a flow-mediated surrogate for pulmonary artery systolic pressure, and a ruptured sinus of Valsalva aneurysm with a high-velocity jet into the right atrium. Because of "washout" artifacts, coronary computed tomography angiography failed to visualize the fistulous tract. Single-stage surgical repair of both lesions achieved complete recovery. DISCUSSION: This case emphasizes color Doppler echocardiography's value in dual-shunt physiology when coronary computed tomography angiography is inconclusive, supporting single-stage surgical repair for multilesion presentations.
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Ahmed et al. (2026) conducted a case report in Ruptured right coronary sinus aneurysm into the right atrium with concurrent perimembranous ventricular septal defect (n=1). Single-stage surgical repair was evaluated on Complete recovery. Single-stage surgical repair achieved complete recovery in a patient with a ruptured right coronary sinus aneurysm and a concurrent perimembranous ventricular septal defect.
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