Definitive diagnosis of ruptured sinus of Valsalva in a patient with ventricular septal defect using cardiac magnetic resonance imaging

Abstract

A 48-year-old man with a history of peri-membranous ventricular septal defect (VSD) without aortic complication was admitted for dyspnoea 1 month after an unfortunate treatment with amoxicillin for a suspected acute bronchitis. The auscultation revealed a loud continuous systolo-diastolic murmur and a thrill through the precordium. The blood pressure was 140/60 mmHg, the ECG was normal except for sinus tachycardia at 90 bpm Chest X-ray showed cardiomegaly and the C-reactive protein was 25 µg/L. Trans-thoracic echocardiography showed a small peri-membranous VSD, a moderate aortic insufficiency and a high-velocity systolo-diastolic flow (5 m/s) in the pulmonary artery, but the different merging flows which confused Doppler …