Original article
Infective endocarditis resulting in rupture of sinus of valsalva with a rupture site communicating with both the right atrium and right ventricle

https://doi.org/10.1016/j.echo.2004.04.033Get rights and content

Abstract

This report describes a patient with a rupture of the noncoronary sinus of Valsalva caused by erosion of its wall by a large right atrial vegetation not attached to the tricuspid valve without aortic valve involvement. The rupture site was located right posterior to the tricuspid septal leaflet and communicated both with the right atrium and the right ventricular inflow tract, resulting in a significant left-to-right shunt leading to severe right heart failure and shock. The diagnosis was made by transthoracic and transesophageal echocardiography. To our knowledge no similar case has been reported in the literature.

Section snippets

Case report

A 59-year-old woman was referred to the surgical department of our hospital because of rectal bleeding. Initial hospital course included history and physical examination. Rectoscopy and colonoscopy revealed only minimal proctitis. Five days later, however, recurrent severe rectal bleeding occurred causing hemorrhagic shock with significant anemia. Repeated urgent rectoscopy revealed an exulceration with arterial bleeding on the anterior wall of the rectum 5 to 6 cm from the anus. The hemorrhage

Discussion

Sinus of Valsalva rupture is usually caused by rupture of an aneurysm of sinus of Valsalva, which may be congenital or aquired. In the reported case, however, an aneurysm of sinus of Valsalva could not be identified. The rupture of sinus of Valsalva in this case was caused by infective endocarditis, ie, the large RA vegetation adjacent to the sinus of Valsalva eroded its wall and resulted in a fistula connecting the noncoronary sinus of Valsalva with the RA and the proximal RV inflow tract. Our

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