Ventricular Septal Aneurysm Mimicking Sinus of Valsalva Aneurysm!

The above 2-D transthoracic echocardiography (TTE) images (A – E) and axial computed tomography (CT) image (F) show a ventricular septal aneurysm (VSA). Image A is a parasternal short axis TTE frame across the aortic valve (AV). Aneurysmal outpouching is seen along the right coronary cusp (RCC) suspicious for a sinus of Valsalva aneurysm of the RCC. Color flow and continuous wave Doppler (green arrow) in image B, however, reveal that there is systolic, high velocity flow across the aneurysm, consistent with a ventricular septal defect (VSD) with a VSA. Image C is an apical 4-chamber TTE view demonstrating the anatomic location of the VSA at the proximal ventricular septum, with high velocity systolic color flow Doppler (green arrow) shown across the VSD in image D. Further, parasternal long axis TTE image (E) and Axial CT with contrast image (F) confirm the location of the aneurysm at the proximal ventricular septum separate from the aortic valve.