Chapter 39

    When the aneurysm is present, but the aneurysmatic wall is intact, no symptomatology is noted.
    When rupture of the aneurysm occurs, it may usually happen in the right ventricle, or the right atrium or occasionally the left ventricle. At times when the aneurysm is located in the non-coronary sinus, rupture in the pericardium may be the case.
    These patients will show typical history of chest pain and shortness of breath of sudden onset followed by congestive heart failure with a permanent murmur secondary to the left to right heart shunt.
    There is a typical progressive deterioration of the patient with Corrigan's pulse (wide pulse) and a hyperkinetic left ventricle due to sudden left ventricular volume overload. If the rupture occurs in the right chambers, biventricular diastolic volume overload will be the case.
    AV conduction disturbances are very often seen in the ECG due to compression of the neighboring conductive electrical structures.
    Otherwise the ECG may eventually show changes of biventricular volume overload depending on the location of the shunt.
    The chest x-ray may show congestive heart failure with a heart shadow of normal size. Finally, for an accurate diagnosis, cardiac catheterization with aortic root angiogram are necessary.
    If the rupture occurs in the pericardium, the picture will be the one of cardiac tamponade.

The picture indicates three of the possible ways of rupture of an aneurysm of the right sinus of Valsalva. Rupture in the pericardium is a possibility too.