A 56-year-old woman suddenly experienced shortness of breath, burning precordial pain, and palpitations in 1973 when she was carrying a suitcase. Apart from recurrent episodes of tachycardia, she remained relatively free of symptoms thereafter, until progressive exertional dyspnea appeared in November 1976, which resulted in admission to our hospital.
On physical examination, she was found to have a blood pressure of 125/50 mm Hg and high-pitched continuous systolic-diastolic murmur without a palpable thrill, at the lower left sternal border. Moderate bilateral cardiac enlargement with some pulmonary congestion was present on chest x-ray film. The ECG showed only ST-T changes caused by digitalis. There was no clinical evidence of right ventricular failure. Her tricuspid valve echocardiogram is shown in the Figure.
What is your diagnosis?
Diagnosis.—Perforated Sinus of Valsalva Aneurysm
The diagnostic echocardiographic findings are limited to the tricuspid valve, which shows prominent high-frequency fluttering in diastole and in systole
Kronik G, Mosslacher H, Slany J. Continuous Systolic and Diastolic Tricuspid Valve FlutteringOccurrence in a Patient With Chest Pain, Dyspnea, and Palpitations. Arch Intern Med. 1978;138(12):1841–1842. doi:10.1001/archinte.1978.03630370051022