A 32-year-old female was referred for evaluation of a continuous murmur heard at the base of the heart with no radiation to the back. She was otherwise healthy, had no complaints and did not show signs of congestive heart failure. She went through two pregnancies without complications. Her colour Doppler echocardiography (Fig. 1a) showed a communication between the right coronary sinus and the right atrium. This was confirmed to be a ruptured sinus of Valsalva aneurysm (SVA) by ascending aortic angiography (Fig. 1b). Subsequently, she was referred for surgical repair.
Fig. 1
(a) Two-dimensional short axis echocardiographic view of the aortic valve with colour Doppler mapping showing aortico-atrial communication (arrow); (b) Left anterior oblique angiographic view of the aortic root showing sinus of valsalva aneurysm and a jet of contrast (arrow) indicating the site of rupture. SVA: sinus of valsalva aneurysm, Ao: aortic valve, RA: right atrium