Ruptured aneurysms of the aortic sinus of Valsalva.

Aneurysms of the aortic sinus of Valsalva (ASV) are uncommon. This study describes eight cases of ruptured aneurysms of the congenital variety observed over a 10-year period in Singapore. Although ASV is classically diagnosed at the time of rupture, only one patient in this series presented with acute chest pain and dyspnea. All eight patients had continuous murmurs. The clinical diagnosis was confirmed by cardiac catheterization and angiography in eight patients and by thoracotomy in six. In six patients, the aneurysm had ruptured into the right ventricle and in two into the right atrium. In the five patients where the site of the aneurysm could be definitely determined, four arose from the right coronary and one from the noncoronary sinus. This marked preponderance of right coronary sinus over noncoronary sinus aneurysm in Singapore is more in accordance with the Japanese rather than the Western experience. A systolic gradient due to the aneurysm pressing on the right ventricular outflow tract was established in four patients during cardiac catheterization and angiography and confirmed in three patients at thoracotomy. Six patients underwent operation and were alive and well from 7 months to 3 years later.