Acute chest pain in a triathlete: rupture of the noncoronary sinus of Valsalva into the right ventricle

Sinus of Valsalva (SoV) aneurysm is a rare cardiac disease. The prevalence of aneurysms originating from the right coronary sinus (65–85%) is the highest, followed by the noncoronary sinus (10–30%), and the lowest in the left coronary sinus (<5%) (1,2). A web-based search revealed an onset of the disease at 35 years of age and that males predominated with about two thirds of the clinical cases (3). Furthermore, Asians are more frequently affected than other ethnic groups (4). Often the patient is asymptomatic. However, a ruptured SoV aneurysm presents a clinical emergency due to formation of hemodynamically relevant aortic cardiac shunts. Diagnosis of this disease and other common causes of acute heart failure rely on echocardiography