case_images: PMC5803984_01
case_images: Significant aorta-to-right ventricular outflow tract shunt through the ruptured sinus of Valsalva (arrow) as imaged at echocardiographic color Doppler analysis (a) and aortic angiography (b). Ao: Aorta; RVOT: Right ventricular outflow tract
case_images: APC-11-86-g001.jpg
case_images: PMC5803984_01_APC-11-86-g001.jpg
case_images: F1
case_images: At cardiac catheterization, moderate RV hypertension (RV/left ventricular pressure ratio 0.6) and severe RV dilatation were found [Figure 1].
case_images: Amplatzer Duct Occluder Type II AS  device (asterisk) during deployment (a). Mild residual foaming through the implanted device after final release (b). Ao: Aorta
case_images: APC-11-86-g002.jpg
case_images: PMC5803984_01_APC-11-86-g002.jpg
case_images: F2
case_images: Aortic angiography showed a 3-mm large rupture of the right coronary sinus into the RV outflow, resulting in moderate significant left-to-right shunt (QP/QS 1.6:1) [Figure 2a]. After deployment, aortic root angiogram revealed mild foaming across the device [Figure 2b] without any aortic valve malfunction or right coronary artery compression.