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420 Mom, I can’t breathe!
  1. Khoironi Omar,
  2. Siew Sing Chua,
  3. Amelia Alias,
  4. Noraini Ab Rahman,
  5. Fong Chiao Lai
  1. Malaysia


Background Sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly, either acquired or congenital. This anomaly most often arises from the right coronary sinus, while less frequently arises from the non-coronary sinus or left sinuses. Ruptured sinus of Valsalva (RSOV), especially if it arises from the right coronary sinus, can cause acute symptoms of right sided heart failure. This is mainly because RSOV from right coronary sinus will lead to communication between aorta and right atrium or right ventricle, leading to a left to right shunt, hence causing right ventricle overload. RSOV can be an isolated lesion or associated with other cardiac lesions e.g. ventricular septal defect (VSD), aortic regurgitation, bicuspid aortic valve, and coarctation of aorta. RSOV rarely occurs in infancy and childhood; it mostly occurs after puberty or between 30’s to 40’s. Early and accurate diagnosis with early surgical intervention is the only way to improve survival in patient with RSOV.

Objectives To provide a review on our detection and management on RSOV.

Methods This is a case report of a teenager who was premorbid well, presented to a district hospital with acute heart failure symptoms.

Results A 14-year-old girl presented with chest pain, orthopnoea and reduced effort tolerance for 4 days. Physical examination revealed pansystolic murmur grade 4 with no hyperactive precordium. The electrocardiogram showed a normal rhythm with sinus tachycardia. Chest imaging showed neither any lung infection nor cardiomegaly. From the preliminary echocardiography, there was presence of turbulence flow in the aortic root with small ventricular septal defect. Ruptured SVA was highly being suspected in this patient. She was started on anti-failure medications. Further assessment was done at tertiary centre by Paediatric Cardiologist, confirming the diagnosis of RSOV. Patient was referred to cardiothoracic team for repair and was discharged well without any post-operative complications.

Conclusions RSOV is a very rare cause of acute heart failure in paediatrics population. RSOV should be suspected in patient with small VSD on follow up, especially if patient present with acute heart failure. The diagnosis requires a high index of suspicion from history, to presentation, to investigation, such as echocardiography. It is a surgical emergency and early surgery is indicated.

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