Right coronary sinus of Valsalva aneurysm with rupture into the right atrium

History and clinical findings: A 58-year-old woman without previous cardiac symptoms developed exertional dyspnoea and peripheral oedema which markedly increased within a two-week period. Auscultation revealed a 4/6-5/6 holosystolic and diastolic machinery murmur. Examinations: Transthoracic and multiplane transoesophageal echocardiography established the diagnosis of a 3 cm aneurysm of the right coronary sinus of Valsalva with clearly demarkated rupture into the right atrium, with a large left to right shunt shown on colour-Doppler echocardiography. These findings were confirmed on cardiac catheterisation, There was no sign of coronary heart disease. Treatment and course: At open-heart surgery the aneurysm was resected, the defect closed with an autologous pericardial patch and the tricuspid valve reconstructed. On follow-up examination the result remained excellent and the patient was free of symptoms. Conclusion: In ruptured aneurysm of the coronary sinus of Valsalva, multiplane transoesophageal echocardiography provides exact diagnosis and optimal planning of the operative procedure.