Ruptured sinus of Valsalva aneurysm with aortic-left atrial fistula.

We report the case of a previously healthy 56-year-old male who suddenly developed severe chest pain and pulmonary edema. Cardiac catheterization and angiography revealed an aneurysm of the noncoronary sinus of Valsalva which had ruptured into the left atrium. This was confirmed at operation and it was noted that there were no signs of bacterial infection or rheumatic valve disease. We therefore concluded that the aneurysm was of congential origin. A successful repair of the defect was carried out and the patient made a satisfactory recovery. There are only 3 other reported cases of rupture of a congenital sinus of Valsalva aneurysm into the left atrium, and in only one case did the aneurysm originate from the noncoronary sinus and this patient had associated rheumatic aortic and mitral valve disease. We have received the classification of sinus of Valsalva aneurysms, the associated congenital and acquired defects and the presenting features of unruptured and ruptured aneurysms.