Echocardiographic diagnosis of ruptured right sinus of Valsalva.

A 36-year-old man was referred to our hospital for a recent finding of a heart murmur. He had no relevant medical history except paroxysmal palpitations in the previous three months. Physical examination revealed a high-grade continuous rumbling murmur best heard at the left sternal border. Initial transthoracic echocardiography showed continuous flow between the aorta and the right ventricle (RV) (Figure 1A). The subsequent transesophageal echocardiogram (TEE) confirmed the presence of a tubular, windsock-like communication 4.5 mm in diameter between the right sinus of Valsalva (RSV) (displayed deformed) and the RV (Figure 1B and 1D, Video 1), with an effective regurgitant orifice of 0.11 cm in color flow Doppler (according to proximal isovelocity surface area measurement) and a systolic-diastolic flow in continuous wave Doppler (Figure 1C). There was also moderate aortic regurgitation