Serendipitous Continuous Murmur in an Octogenarian Turned Out to be an Asymptomatic Ruptured Sinus of Valsalva

Abstract

Sinus of Valsalva aneurysm is a rare cardiac anomaly which is more often congenital than acquired. Rupture of the aneurysm can present as plain as an asymptomatic murmur to as dramatic as a myocardial infarction or cardiogenic shock or even death. Ruptured sinus of Valsalva (RSOV) is very rare in the elderly, and an asymptomatic rupture in an octogenarian is rarer still. An octogenarian, accompanying his wife for her diabetic follow-up, was found to have a continuous murmur by chance examination. Echocardiography unmasked a RSOV; surprisingly, the elderly man was completely asymptomatic. The patient was referred to a cardiothoracic center for further management. A RSOV is a precarious disposition needing prompt recognition and urgent intervention even though asymptomatic. This case report highlights the importance of recognizing such entities even among the elderly despite its rarity. This case also highlights the cardiovascular auscultation as one of the most important, simple, and inexpensive clinical investigations.