[Echocardiographic diagnosis of aneurysm of Valsalva's sinus with fistulization into the right atrium].

The preoperative diagnosis of an aneurysm of the posterior sinus of Valsalva with rupture into the right atrium was made by echocardiography in a 21-year-old patient. The M-mode echocardiography revealed the following findings: 1) a vibrating anomalous structure, continuous with the aortic wall, was present in the right atrium. The echo-producing mass was the wall of the aneurysm, which adhered to the septal leaflet of the tricuspid valve during early-to-mid systole and had an abrupt posterior motion in late systole. In diastole, the wall of the aneurysm descended into the tricuspid orifice and its motion was similar to that of the septal leaflet of the tricuspid valve; 2) an echocardiographic sweep from the aorta to the left ventricle showed that the posterior wall of the aorta "crossed" the mitral orifice; 3) the pulmonic and tricuspid valves were normal. The 2-D echocardiographic findings gave support to the M-mode diagnosis: 1) in the short-axis view (at the level of the aorta) two lines of echoes came off the right side of the aortic wall and invaded the right atrium. These echoes were produced by the walls of the aneurysm; 2) in the apical four-chamber view the aneurysm descended into the tricuspid orifice in diastole, whereas it was lifted by the septal leaflet of the tricuspid valve in systole. The aneurysm appeared as vibrating lump on the closed tricuspid valve. Recognition of these features provides a potential non-invasive way to diagnose this anomaly. To our knowledge this is the first description of the characteristic echocardiografic picture of an aneurysm of the sinus of Valsalva with rupture into the right atrium.