Premature pulmonic valve opening following sinus of Valsalva aneurysm rupture into the right atrium.

Echocardiographic features of a patient with sinus of Valsalva aneurysm rupture into the right atrium are described. The aneurysm presented as a dense echo-producing mass in the right atrium which descended into the tricuspid orifice during diastole and withdrew back into the atrium during ventricular systole. Pulmonic valve exho motion demonstrated early diastolic pulmonic valve opening indicating an early right ventricular diastolic pressure rise exceeding simultaneous pulmonary artery pressure. Since the aorta is the only source of early diastolic pressure in excess of pulmonary artery pressure available to the right heart, this finding of early diastolic pulmonic valve opening indicated the presence of a fistula between the aorta and right heart. Other interesting echocardiographic features of this case are also presented.