Role of cardiac MRI in complicated cardiac defects

Sinus of Valsalva rupture is a rare condition that results in aortocardiac shunt. Although the investigation of choice is transthoracic echocardiography, the gold standard is cardiac catheterization. We present a case of a young male with acute onset heart failure. Acute coronary syndrome blood workup was unremarkable. Transthoracic and transesophageal echocardiography revealed mild right atrial dilation with a Gerbode shunt. Right heart catheterization showed left to right shunt suggestive of acquired acute onset shunting. Eventually, a cardiac MRI revealed a ruptured sinus of Valsalva opening into the right atrium as the cause. The patient was taken to the operation theater where an aortobicaval bypass was established. A horizontal aortotomy revealed a sinus of Valsalva aneurysm arising from the right coronary sinus which was repaired using a Dacron patch. Postoperative transthoracic echocardiography showed no defect. In summary, cardiac MRI is an excellent tool for establishing a definite diagnosis for complicated cardiac defects