{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T20:10:37Z","timestamp":1784837437806,"version":"3.55.0"},"reference-count":6,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":8,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sinus of Valsalva aneurysm is a rare structural anomaly that could be congenital or acquired, usually silent until the moment of rupture. Its diagnosis can be challenging as the turbulent jet flow may mimic vegetations or abscesses associated with infective endocarditis (IE).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>A 31-year-old woman with Down syndrome presented with signs of severe right heart failure and a history of recurrent fevers. Initial echocardiography revealed a massive left-to-right shunt and an echogenic structure in the aortic root, raising suspicion of a paravalvular abscess\u2014patient was treated initially with intravenous antibiotics. However, due to negative blood cultures and imaging findings (coronary computed tomography and cardiac magnetic resonance), lesion was reclassified as a ruptured non-coronary sinus of Valsalva aneurysm (RSOV) fistulizing into the right atrium (Qp:Qs 3.5). Due to the ambiguity of the diagnosis and initial clinical stability, elective surgery was planned after antibiotics course was completed and heart failure treatment optimalization. One month later, the patient presented with acute heart failure event with distribution shock. Emergency surgery was performed. Intraoperative findings confirmed RSOV without signs of infection. The aneurysm was excised with fistula closure, and the aortic valve replaced. The patient made a full recovery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This case highlights the diagnostic overlap between RSOV and IE. It underscores the critical role of multimodality imaging in excluding infection and defining anatomy. Furthermore, it demonstrates that in cases of massive left-to-right shunting, delaying surgery carries a high risk of rapid haemodynamic collapse.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytag495","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T11:49:50Z","timestamp":1783511390000},"source":"Crossref","is-referenced-by-count":0,"title":["Ruptured sinus of Valsalva aneurysm mimicking infective endocarditis in a patient with Down syndrome: case report"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4471-9004","authenticated-orcid":false,"given":"Jan","family":"Harpula","sequence":"first","affiliation":[{"name":"Department of Cardiology and Structural Heart Diseases, Medical University of Silesia , Ziolowa 45 Street, Katowice 40-514 ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7553-2026","authenticated-orcid":false,"given":"Julia","family":"Seku\u0142a","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Structural Heart Diseases, Medical University of Silesia , Ziolowa 45 Street, Katowice 40-514 ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pawe\u0142","family":"\u017burek","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Medical University of Silesia , Ziolowa 45 Street, Katowice 40-514 ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3681-5207","authenticated-orcid":false,"given":"Wojciech","family":"Wojakowski","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Structural Heart Diseases, Medical University of Silesia , Ziolowa 45 Street, Katowice 40-514 ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ewa","family":"Peszek-Przyby\u0142a","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Structural Heart Diseases, Medical University of Silesia , Ziolowa 45 Street, Katowice 40-514 ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"2026072315363689100_ytag495-B1","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1159\/000092635","article-title":"Aneurysms of the sinuses of Valsalva","volume":"106","author":"Feldman","year":"2006","journal-title":"Cardiology"},{"key":"2026072315363689100_ytag495-B2","first-page":"CS135","article-title":"Ruptured sinus of Valsalva aneurysm in a child with down syndrome: a rare cardiac anomaly","volume":"16","author":"Benatar","year":"2010","journal-title":"Med Sci Monit"},{"key":"2026072315363689100_ytag495-B3","doi-asserted-by":"crossref","first-page":"177","DOI":"10.4103\/jcecho.jcecho_37_19","article-title":"Ruptured sinus of Valsalva aneurysm mimicking infective endocarditis in DiGeorge syndrome","volume":"29","author":"Bhimani","year":"2019","journal-title":"J Cardiovasc Echogr"},{"key":"2026072315363689100_ytag495-B4","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1136\/hrt.64.3.195","article-title":"Echocardiographic diagnosis of a ruptured aneurysm of the sinus of Valsalva: operation without catheterisation in seven patients","volume":"64","author":"Sahasakul","year":"1990","journal-title":"Br Heart J"},{"key":"2026072315363689100_ytag495-B5","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":"2026072315363689100_ytag495-B6","doi-asserted-by":"crossref","first-page":"1573","DOI":"10.1016\/S0003-4975(99)01045-0","article-title":"Sinus of Valsalva aneurysm or fistula: management and outcome","volume":"68","author":"Takach","year":"1999","journal-title":"Ann Thorac Surg"}],"container-title":["European Heart Journal - 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