Torres S, Pereira L S, Martins L, Gomes L, Pimenta A
Serviço de Cardiologia, Hospital Geral de Santo António, Porto.
Rev Port Cardiol. 1990 Jan;9(1):51-5.
A 37 year old man was referred to our institution because of a cardiac murmur, exertional dyspnea and fatigue, symptoms that began since 18 years of age. He reported a cardiac murmur since childhood, with no past history of rheumatic fever or infectious endocarditis. On clinic examination there was a systolic-diastolic murmur louder in the third and fourth left intercostal space, just at the sternal left border. The 2 D-echo revealed a small disruption in the aorto-septal continuity. Right heart catheterisation was performed, showing an increased pressure in the pulmonary artery and right ventricle; an increase in the oxygen saturation on the right heart chambers, suggested the presence of a left-to-right shunt, nevertheless the exact location of the defect was not possible to recognise. The study was complemented with Doppler color flow imaging that revealed a turbulent flow through the defect, with blood flowing from the aortic root into the right ventricular outflow tract. The diagnosis of ruptured aneurysm of sinus of Valsalva was made, being confirmed later by aortic angiography. A rare case is reported in which an aneurysm of the right coronary sinus ruptured into the right ventricle; we emphasize the important contribution of the Doppler color flow imaging to the correct diagnosis, technique rarely described in this type of complication.
一名37岁男性因心脏杂音、劳力性呼吸困难和疲劳前来我院就诊，这些症状自18岁起就开始出现。他自述自幼就有心脏杂音，既往无风湿热或感染性心内膜炎病史。临床检查发现，在胸骨左缘第3、4肋间有一响亮的收缩期-舒张期杂音。二维超声心动图显示主动脉-间隔连续性有一小处中断。进行了右心导管检查，结果显示肺动脉和右心室压力升高；右心腔血氧饱和度升高，提示存在左向右分流，但无法确定缺损的确切位置。通过多普勒彩色血流成像对该研究进行补充，结果显示有一股湍流通过缺损处，血液从主动脉根部流入右心室流出道。诊断为瓦氏窦瘤破裂，后来经主动脉血管造影证实。本文报告了一例罕见的右冠状动脉窦瘤破裂入右心室的病例；我们强调了多普勒彩色血流成像对正确诊断的重要作用，而这种技术在这类并发症中很少被描述。
