Answer to the Quiz: Imaging and case discussion

Transthoracic echocardiography (TTE) showed normal left ventricular systolic function (ejection fraction 65%), left ventricular hypertrophy (interventricular septum 1.5 cm, posterior wall 1,5 cm), left atrial dilatation (4.8 cm), right ventricular dilatation (3.2 cm), normal left ventricular end-diastolic diameter (5.2 cm) and a cystic-like structure (aneurysm) in the right ventricle adjacent to the interventricular septum (see Fig. 1, 2 – p. XX), located from the base of the septum to its mid-ventricular portion. In color Doppler imaging, turbulent flow was seen from the aorta into the aneurysmatic sac and from its cavity into the right ventricle (RV) (see Fig. 1, 3 pXX). Continuous-wave Doppler revealed continuous high-velocity flow from the aorta into the aneurysm and from its cavity into the RV during both phases of the cardiac cycle (systole and diastole) (see Fig. 4 – page XX). The estimated Qp/Qs ratio was 1.54. Systolic pulmonary artery pressure was 60 mm Hg. Aortic valve was tricuspid with mild regurgitation. Right sinus of Valsalva aneurysm (SVA) with interventricular septum dissection and rupture into the RV was suspected. Contrast-enhanced multidetector computed tomography (MDCT) confirmed the diagnosis (Fig. 1, 2). Syphilis and other infections were excluded during differentiation between congenital and acquired sinus of Valsalva aneurysm. The patient had a fall from height 2 years earlier, which could be a trigger for rupture of his congenital malformation. Coronary angiography showed normal coronary arteries. Surgical repair of the aneurysm and dissection with a patch was performed successfully.