The (M-mode) echocardiographic patterns of three patients with congenital aneurysm of the right sinus of Valsalva are reported. In two patients the aneurysm ruptured into the right ventricular cavity. In the third case, in which the lesion was associated with coarctation of the aorta, no communication was shown between the aorta and other cardiac chambers. The characteristic echocardiographic features of the right coronary sinus aneurysm (either with or without rupture in the right ventricular cavity) consist of: 1) The presence of echoes (referable to the right aortic cusp pattern of motion) encroaching the right ventricular outflow tract. 2) The presence of the same box-shaped echoes at a low level of the left ventricular cavity, which seem to "cross" the septum (from the left to the right ventricular outflow tract). These images would reflect the "prolapse" of the affected cusp. Other common, but non-specific echocardiographic features of the lesion are: an indistinct contour of the anterior wall of the aortic root (probably due to dilatation of the right coronary sinus) and systolic indentations on the right anterior aortic cusp echoes.
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