A Case of Perimembranous Ventricular Septal Defect with worsening clinical condition. Is a relook at the Echocardiography warranted?? – An Interesting Case Report

An aneurysm of Sinus of Valsalva (most commonly right sinus) is a rare finding, which may be congenital or acquired. A ruptured Sinus of Valsalva aneurysm (RSOVA) may lead to serious complications including myocardial ischemia, obstruction of right ventricular outflow tract and cardiac tamponade and warrants urgent repair – either surgical or percutaneous. We present a case which was pre-diagnosed with VSD and referred to our centre where clinical   evaluation revealed continuous murmur and on transthoracic echocardiography a large left to right shunt with continuous flow (predominant diastolic flow) was observed. It was only diagnosed as a RSOVA when Transesophageal echocardiography (TEE) was performed when patient was taken to Cath lab for urgent percutaneous device closure of septal defect.  Although rare, a missed diagnosis of RSOVA can be catastrophic as it has serious consequences and warrants urgent repair – either surgical or percutaneous. The role of TEE cannot be undermined in its diagnosis.