{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T04:10:24Z","timestamp":1782706224398,"version":"3.54.5"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2023,2,28]],"date-time":"2023-02-28T00:00:00Z","timestamp":1677542400000},"content-version":"vor","delay-in-days":27,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,2,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Sinus of valsalva aneurysms (SOVAs) are infrequent findings and generally diagnosed incidentally. A SOVA may be at risk for rupture, which would lead to an aorto-cardiac shunt. These patients present similarly to decompensated heart failure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case Presentation<\/jats:title><jats:p>We present a case of a 44-year-old female with a ruptured non-coronary SOVA diagnosed by echocardiogram during evaluation for exertional dyspnoea. A trans-oesophageal echocardiogram (TEE) revealed a 2.1\u2005cm non-coronary SOVA with windsock communication to the right atrium. The patient refused surgery, and two years later, presented with florid right heart failure with preserved left ventricular function. The right ventricle was severely dilated and hypokinetic with right atrial enlargement. After finally agreeing to surgery, a pre-operative catheterization revealed non-obstructive coronaries and a significant left to right shunt with elevated pulmonary pressure. The patient had suboptimal response to diuretic therapy and was sent for successful repair of the aneurysm with the closure of the aorto-atrial fistula via bovine pericardial patch and resolution of the left to right shunt as demonstrated by intra-operative TEE. Her right-sided heart failure symptoms subsequently resolved.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>SOVA is a rare finding but should still be considered in the differential in young and middle-aged patients with symptoms of acute heart failure, hemodynamic compromise, and a new continuous heart murmur. Early surgical repair is highly recommended to prevent acute and long-term complications.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ehjcr\/ytad018","type":"journal-article","created":{"date-parts":[[2023,2,1]],"date-time":"2023-02-01T18:36:55Z","timestamp":1675276615000},"source":"Crossref","is-referenced-by-count":4,"title":["A rare variant of a ruptured sinus of valsalva aneurysm forming an aorto-atrial fistula: a case report and review of literature"],"prefix":"10.1093","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1806-1798","authenticated-orcid":false,"given":"John S","family":"Dayco","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Cardiology, Wayne State University , 4201 St Antoine St, Suite 2E, Detroit, MI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alyssa","family":"Dsouza","sequence":"additional","affiliation":[{"name":"Wayne State University School of Medicine , 4201 St Antoine St, Suite 2E, Detroit, MI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Baciewicz","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Cardiothoracic Surgery, Wayne State University , 4201 St Antoine St, Suite 2E, Detroit, MI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaun","family":"Cardozo","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiology, Wayne State University , 4201 St Antoine St, Suite 2E, Detroit, MI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,2,1]]},"reference":[{"key":"2023030116260243900_","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1002\/clc.22359","article-title":"Sinus of valsalva aneurysms: review of the literature and an update on management","volume":"38","author":"Weinreich","year":"2015","journal-title":"Clin Cardiol"},{"key":"2023030116260243900_","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1016\/j.amjcard.2006.11.047","article-title":"Sinus of valsalva aneurysms\u201447 years of a single center experience and systematic overview of published reports","volume":"99","author":"Moustafa","year":"2007","journal-title":"Am J Cardiol"},{"key":"2023030116260243900_","doi-asserted-by":"crossref","first-page":"146","DOI":"10.12998\/wjcc.v1.i4.146","article-title":"Noncoronary sinus of valsalva rupture into the right atrium with a coexisting perimembranous ventricular septal defect","volume":"1","author":"Cao","year":"2013","journal-title":"World J Clin Cases"},{"key":"2023030116260243900_","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1093\/ejcts\/ezs450","article-title":"Surgery for ruptured sinus of valsalva aneurysm: 25-year experience with 55 patients","volume":"43","author":"Sarikaya","year":"2013","journal-title":"Eur J Cardiothorac Surg"},{"key":"2023030116260243900_","doi-asserted-by":"crossref","first-page":"e308","DOI":"10.1161\/CIRCULATIONAHA.107.730325","article-title":"Images in cardiovascular medicine. 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