Noncoronary sinus of Valsalva rupture into the right atrium with a coexisting perimembranous ventricular septal defect

Figure 1 Electrocardiogram shows sinus tachycardia with a rate of 130, 1 mm to 3 mm ST depressions in leads I, II, and V3 to V6 and 1 mm to 2 mm ST elevations in aVR and V1.

Figure 2 Subsequent transesophageal echocardiogram done, showed a ruptured aneurysm of the noncoronary sinus of Valsalva, that is Windsock in morphology, into the right atrium. A: Sinus of Valsalva defect with; B: Color-Doppler. 1: Windsock aneurysm; RV: Right ventricle; NC: Noncoronary cusp.

Figure 3 Patient underwent immediately surgery to repair both the ruptured aneurysm of the noncoronary sinus of Valsalva and the ventricular septal defect. A: Bubbles going through membranous ventricular septal defect; B: The repaired defect. Asterisk indicates micro air bubble traversing the membranous VSD. RV: Right ventricle; NC: Noncoronary cusp.