Ruptured Sinus of Valsalva Aneurysm: An Unexpected Cause of Respiratory Failure.

CASE SUMMARY: We address a case of a young patient with a history of asymptomatic ventricular septal defect, presenting with sudden-onset dyspnea requiring prolonged mechanical ventilation, who developed decompensated right heart failure. A sinus of Valsalva aneurysm rupture, leading to aortopulmonary fistula, was diagnosed. The patient underwent surgical repair with bovine patch and commissural annuloplasty and was discharged after an uneventful postoperative course.

TAKE-HOME MESSAGE: This rare case of a ruptured sinus of Valsalva aneurysm in a patient with a known ventricular septal defect demonstrates that the coexistence of 2 left-to-right shunts is a diagnostic challenge requiring a thorough echocardiographic evaluation and a multidisciplinary approach, but one that can be successfully managed with timely surgical intervention.