RIGHT SINUS OF VALSALVA RIGHT ATRIAL FISTULA SECONDARY TO NONPENETRATING CHEST TRAUMA - CASE-REPORT WITH DESCRIPTION OF NON-INVASIVE DIAGNOSTIC FEATURES

A sinus of Valsalva-right atrial fistula secondary to nonpenetrating chest trauma is described. Echocardiography demonstrated diastolic fluttering of the anterior tricuspid valve, suggesting a left-to-right shunt at the level of the right atrium. External jugular venous pulse tracings revealed large a waves and attenuation of the y descent. Cardiac catheterization disclosed a fistulous communication between the right sinus of Valsalva and right atrium. After surgical repair of the fistula, the ultrasonic recording and external pulse tracing reverted to normal. We believe this is the first description of such a shunt after blunt thoracic trauma.