Rupture of aneurysm of aortic sinus (of Valsalva) into the right side of the heart.

We were fortunate enough to see two examples of rupture of a sinus of Valsalva into the right side of the heart within a few months of each other, and were so struck by the similarity in the clinical pictures that we looked up the recorded cases to see whether the syndrome presented by our patients was at all common. We have attempted to study the incidence of clinical findings that might serve as a guide to recognition of the syndrome in the future. The clinical diagnosis of our first case was confirmed by catheterization and was so likely that surgical correction was attempted. The second patient was too ill to permit of catheterization, but again a confident clinical diagnosis was made and subsequently confirmed at autopsy, In spite of failure to correct our first case surgically, from a study of the nature of the rupture its repair should prove feasible if a heart-lung machine is available, particularly as following a small rupture, such as our first case showed, the patient may live for several months. Although there are many anatomical descriptions of aneurysms of one or more sinuses of Valsalva, the number of cases in which rupture has occurred is not great. We have considered only those cases of rupture that have lived long enough to develop symptoms and signs, and, with one exception, we have ignored those where no autopsy confirmation was available. The case in which no autopsy was made but where the diagnosis seemed to us to be irrefutable is that of Arias and Baudino (1952). Including our own two cases we have been able to find 23 convincing examples of the syndrome. It seems very doubtful whether previously the diagnosis has been made in life, although a few authors state that it was suspected among other possibilities. The suggestion that such a diagnosis during life is feasible is usually attributed to Maude Abbott (1919) but she herself states that the clinical features of abnormal communication between a sinus of Valsalva and the right side of the heart were first clearly outlined by Thurnam in 1840. As a matter of historical accuracy precedence should be given to James Hope who, in the third edition of A Treatise on Diseases of the Heart and Great Vessels, published details of Thurnam's case a year earlier.