Typical echocardiographic appearance of a ruptured sinus of Valsalva aneurysm in a previously healthy 30-year-old man.

Fig. 1. Transverse midesophageal plane at 458, demonstrating the short axis of the aortic valve in diastole. The ruptured aneurysm of the right coronary sinus protrudes into the right atrium just above the tricuspid valve producing the characteristic ‘windsock’ appearance described in textbooks. Colour-flow Successful surgical repair of a ruptured sinus of Valsalva aneurysm was performed in a 30-year-old man, presenting with acute onset dyspnoea. Transoesophageal echocardiography demonstrated the characteristic ‘windsock’ appearance of the aneurysm described in textbooks and the continuous flow between the aorta and the right atrium corresponding to a continuous murmur. During surgery an 8 mm opening was identified in the right coronary sinus leading into the right atrium, the aneurysm tissue in the right atrium was excised and the base oversewn, whilst a patch of pericardium was used to close the defect from the aortic end (Figs. 1 and 2). Doppler demonstrates continuous blood flow through the ruptured aneurysm between the aorta and the right atrium, corresponding to the continuous murmur. RA (right atrium), LA (left atrium), RV (right ventricle), TV (tricuspid valve), PV (pulmonary valve), PA (pulmonary artery), LCC (left coronary cusp), NCC (non-coronary cusp), RCC (right coronary cusp). Appendix. Supplementary material