Rupture of a congenital sinus of Valsalva aneurysm presenting as acute heart failure

A 54 year old woman was admitted to a hospital because of acute thoracal pa in, dyspnea, and clinical signs of overt right heart failure. Transthoracic and multiplane echocardiography established the diagnosis of a ruptured an eurysm of the right coronary sinus of valsalva into the right atrium which could be confirmed by cardiac catheterization. During heart surgery, which was done without complications, the defect was closed with a suture. Six mo nths later echocardiography showed a normal right ventricle; the function o f the aortic valve was regular. Acute heart failure may be due to a congeni tal structural cardiac anomaly in spite of the age of 54. In such condition s transthoracic and especially transesophageal echocardiography serve as no ninvasive excellent tools to make an exact diagnosis.