Two cases of aortico-ventricular fistulae.

An acquired fistulous communication between the aorta and the right ventricle, caused by syphilitic infection and rupture of an aneurysmal dilation of the right sinus of Valsalva, has been reported by Tompkins (1941). Schuster (1937) made mention of a similar mycotic rupture. Mall (1912) attributed the giving way of the wall in this region to the presence of a congenital weakness. The anatomical disposition of the three sinuses of Valsalva in relation to the rest of the heart was defined by Micks (1940) in his report of unruptured aneurysms of all three sinuses. Rupture of any one of the three sinuses, right, left, or posterior could occur. When the right sinus which is associated with the right coronary artery ruptures, it does so either into the right ventricle or the rigbt atrium. The left sinus, associated with the left coronary artery, is related to the pericardial sac rather than the ventricular chambers: when it ruptures communication is established with the pericardial cavity, and death ensues rapidly through acute compression of the heart. On the other hand, communication with the chambers of the heart or with the adjacent pulmonary artery is compatible with life.