Ruptured Sinus of Valsalva Aneurysm in a Patient with a Ventricular Septal Defect Who Dropped Out of Lifelong Medical Follow-up.

Ruptured sinus of Valsalva aneurysm (RSOVA) is a rare cardiac condition associated with high morbidity and mortality rates. We herein report a 35-year-old man with a history of ventricular septal defect (VSD). He had a history of interrupted hospital visits and presented to the emergency department with dyspnea, palpitations, and dizziness for a few days. Auscultation detected a continuous murmur. Transthoracic echocardiography followed by transesophageal echocardiography demonstrated RSOVA in the right ventricle with an aorto-right ventricular fistula. The fistula was resected, and the aneurysm was surgically repaired. The patient made a good recovery.

What to look for in patient with continuous murmur and history of ventricular septal defect?

During diagnostic process it is very important to conduct scrupulous interview and thorough physical examination. Properly interpreted auscultation phenomena allow for appropriate planning of further imaging studies.

Aorto-left atrial fistula secondary to infective aortic endocarditis and endarteritis in a cat with valvular aortic stenosis.

A cat previously diagnosed with valvular aortic stenosis developed acute respiratory distress. A new continuous heart murmur was noted on physical exam. Echocardiographic examination revealed vegetative lesions on the aortic valve and continuously shunting blood flow from the aorta into the left atrium. Despite initial treatment for left-sided congestive heart failure, the cat died suddenly. In addition to confirming aortic valve endocarditis and an acquired aorto-left atrial shunt, pathological examination identified vegetative lesions on the luminal surface of the ascending aorta. Although antemortem aerobic blood culture, 16s bacterial ribosomal DNA PCR, and Bartonella PCR failed to identify causative organisms, Escherichia coli was identified on postmortem tissue culture of the aortic lesion. This represented a unique case of primary valvular aortic stenosis with secondary infective aortic endocarditis, infective aortic endarteritis, and aorto-left atrial fistula in a cat. It highlighted potential adverse outcomes of aortic stenosis that are more commonly recognized in humans and dogs.

Aorto-right pulmonary venous fistula after mitral valve replacement for prosthetic mitral valve infective endocarditis: a case report.

BACKGROUND: Aorto-cavitary fistula is a rare condition, and the most common underlying aetiology is infective endocarditis (IE) of the native or the prosthetic aortic valve. We report a case of aorto-right inferior pulmonary venous fistula following redo mitral valve replacement (MVR) for prosthetic mitral valve IE. CASE SUMMARY: A 74-year-old woman underwent urgent redo MVR for prosthetic mitral valve IE. The post-operative course was complicated with heart failure and mediastinal haematoma compressing the left atrium. The haematoma was surgically removed and laceration of the left atrial wall was suture ligated; this was attributed to the surgical trauma dissection of the adhesive tissues. One-week post-operatively, a continuous murmur emerged, which prompted an evaluation of the left to right shunt. Transthoracic echocardiography revealed an echolucent area posterior to the aorta, with continuous flow on colour Doppler. Three-dimensional computed tomography showed a fistula between the aorta and the right inferior pulmonary vein. There was a high risk involved in surgical management; therefore, she was managed medically. Fortunately, the continuous murmur and echolucent space disappeared after 6 months. The fistula was considered to be obstructed by spontaneous thrombus formation in the narrowed segment of the fistula tract. DISCUSSION: The cause of fistula was attributed to possible surgical trauma in the presence of infection. The present case was unique, as it showed spontaneous healing of an aorto-cavitary fistula, which is very rare. The patient was alive with good health status, 6 years after the MVR.

Aneurisma del seno de Valsalva roto con fístula a ventrículo derecho. Presentación de un caso clínico y revisión de la literatura / Aneurisma do seio de Valsalva roto com fístula para ventrículo direito. Apresentação de um relato de caso e revisão da literatura / Valsalva sinus aneurysm ruptured with right ventricular fistula. Presentation of a clinical case and review of the literature

La presencia de un aneurisma de seno de Valsalva es bastante rara. Esta condición anatómica puede terminar en la ruptura y fistulización a diferentes estructuras cardíacas, con una posible evolución clínica catastrófica. El diagnóstico de esta enfermedad puede resultar laborioso; sin embargo, un dato clínico importante es la presencia de un soplo continuo, que aunque no es específico de esta patología, orienta en el abordaje y detección de posibles causas. La conjunción de la clínica, los hallazgos ecocardiográficos y hemodinámicos, mediante angiocardiografía, resulta primordial en la adecuada caracterización de esta anomalía. De acuerdo a su historia natural, todos los pacientes deben ser tratados quirúrgicamente.

The presence of a Valsalva sinus aneurysm is quite rare. This anatomical condition can end in the rupture and fistulization to different cardiac structures, with a possible catastrophic clinical evolution. The diagnosis of this disease can be laborious; however, an important clinical finding is the presence of a continuous murmur, which although not specific to this pathology, guides in the approach and detection of possible causes. The conjunction of clinic, echocardiographic and hemodynamic findings, through angiocardiography, is primordial in the adequate characterization of this anomaly. According to their natural history, all patients should be treated surgically.

A presença de um aneurisma do seio de Valsalva é muito rara. Esta condição anatômica pode resultar em ruptura e fistulización de diferentes estruturas cardíacas, com uma possível evolução clínica catastrófica. O diagnóstico desta doença pode ser trabalhoso; no entanto, um importante achado clínico é a presença de um sopro contínuo, que embora não seja específico para esta doença, orientada na abordagem e detecção de possíveis causas. A combinação de achados clínicos, ecocardiográficos e hemodinâmicos por angiografia é fundamental na caracterização adequada desta anomalia. De acordo com a sua história natural, todos os pacientes devem ser tratados cirurgicamente.

To evaluate the prevalence of symptomatic and non-symptomatic ductus arteriosus and accuracy of physical signs in diagnosing PDA in preterm infants using blinded comparison of clinical and echocardiographic findings during the first week of life: a prospective observational study from Iran.

AIMS: To evaluate the prevalence of symptomatic and non-symptomatic ductus arteriosus (PDA) and accuracy of physical signs in diagnosing PDA in preterm infants using blinded comparison of clinical and echocardiographic findings during the first week of life. METHODS AND MATERIAL: This prospective observational cross-sectional study enrolled 200 preterm infants, who underwent echocardiography on 4th-7th postnatal day. The neonates who were diagnosed to have PDA on echo were observed for clinical features of PDA to label it symptomatic PDA. Symptomatic PDA was defined as detecting one or all of these symptoms in a neonate with PDA: bounding pulse, pericardial hyperactivity, systolic or continuous murmur. RESULTS: Forty-five infants had PDA on echocardiography. 66.7% neonates with PDA were symptomatic and the most prevalent symptom in them was heart murmur (100%) either alone or combined with other clinical features. Isolated murmur was seen in 31.2%, murmur and hyperdynamic precordium was seen in 8.8%, murmur and bounding pulses were seen in 6.67% and all three features simultaneously were seen in 20% of infants. The sensitivity of murmur for diagnosing symptomatic PDA was highest. CONCLUSION: Presence of murmur is the most important clinical feature for diagnosis of symptomatic PDA and has good specificity.

An elephant trunk appearance-what is the diagnosis?

Coronary cameral fistula is a rare congenital cardiac abnormality. An 18-year-old boy presented with features of right heart volume overload. Clinical examination was suggestive of hyperdynamic circulation with continuous murmur in precordium. 2D echocardiography showed dilated right coronary artery, and 3D echocardiography added information in tracing the track of the fistula which was consistent with the diagnosis of right coronary cameral fistula draining into the right ventricle. Coronary angiograms revealed an unusually dilated right coronary artery giving the appearance of an "elephant trunk" and with a fistulous tract into the right ventricle. Considering the higher risks of surgery in such difficult cases, we performed a successful transcatheter closure of the fistula using an Amplatzer vascular plug.

Asymptomatic spinal arteriovenous fistula presenting only as continuous murmur.

Spinal arteriovenous fistula is extremely rare in children. Weakness and sensory disturbance in the lower extremities are the specific clinical presentations. Children, however, commonly have no subjective symptoms; in rare cases, a continuous murmur is the only physical finding. An 18-month-old boy was referred for evaluation of a continuous murmur audible at the back. He had no motor or sensory disorder; only a Levine 3/6 continuous murmur audible at the back was found. Echocardiography showed a structurally normal heart but indicated ascending continuous blood flow behind the aortic arch and dilatation of the innominate vein. We suspected spinal arteriovenous fistula, and it was visualized on computed tomography angiography. Spinal arteriovenous fistula was detected using only auscultation and echocardiography. Suspicion of this anomaly on careful auscultation and simple examination, and confirmation on detailed examination, even in the absence of motor or sensory disturbance, is important.

Careful Auscultation after Detection of Bacteremia Leading to a Diagnosis of Patent Ductus Arteriosus in Adult / General Medicine

A 40-year-old woman visited our emergency room (ER) with fever and shaking chills. Blood cultures for suspicion of urinary tract infection revealed bacteremia two days later. Since <i>Streptococcus mitis</i> was detected, infective endocarditis was strongly suspected. In addition to her history of dental calculus removal, careful cardiac auscultation revealed a continuous murmur, leading to the existence of patent ductus arteriosus (PDA). PDA was confirmed by echocardiography and 3D-CT angiography. The patient was successfully treated by antibiotics and then received transcatheter PDA closure. Careful auscultation after detection of bacteremia led to a diagnosis of PDA.

Continuous murmur--the auscultatory expression of a variety of pathological conditions.

Continuous murmur is a peculiarity of cardiovascular auscultation, relatively rare, which often hides complex cardiovascular diseases. This article is a review of literature data related to the continuous murmurs accompanied by commenting and illustrating them through our own cases.Recognizing of a continuous murmur and understanding the cardiovascular pathologies that it can hide, is a challenge in current practice.

An uncommon cause of a continuous murmur.

Aneurysms of the sinus of Valsalva are rare congenital lesions. Less often, they are encountered secondary to trauma, infective endocarditis or syphilis. The majority of these aneurysms arise from the right coronary sinus. The present report describes a rare case of an aneurysm arising from the noncoronary sinus of Valsalva and rupturing into the right atrium. Patients with unruptured aneurysms often remain asymptomatic. Rupture of the aneurysm usually causes the appearance of a continuous murmur in the left sternal border. Common sites of rupture include the right ventricle, right atrium or left atrium. Surgical repair is usually associated with a favourable outcome.