[The perforation of a right-coronary sinus of Valsalva aneurysm into the right atrium].

HISTORY AND CLINICAL FINDINGS

A 58-year-old man [correction of woman] without previous cardiac symptoms developed exertional dyspnoea and peripheral oedema which markedly increased within a two-week period. Auscultation revealed a 4/6-5/6 holosystolic and diastolic machinery murmur.

EXAMINATIONS

Transthoracic and multiplane transoesophageal echocardiography established the diagnosis of a 3 cm aneurysm of the right coronary sinus of Valsalva with clearly demarcated rupture into the right atrium, with a large left to right shunt shown on colour-Doppler echocardiography. These findings were confirmed on cardiac catheterisation. There was no sign of coronary heart disease.

TREATMENT AND COURSE

At open-heart surgery the aneurysm was resected, the defect closed with an autologous pericardial patch and the tricuspid valve reconstructed. On follow-up examination the result remained excellent and the patient was free of symptoms.

CONCLUSION

In ruptured aneurysm of the coronary sinus of Valsalva, multiplane transoesophageal echocardiography provides exact diagnosis and optimal planning of the operative procedure.