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Silent rupture of sinus of Valsalva aneurysm: a refutation of the Okham's razor principle

Published online by Cambridge University Press:  24 May 2011

Joseph Dayan
Affiliation:
Department of Pediatrics, New York Medical College, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, United States of America
Suvro Sett
Affiliation:
Department of Pediatric Cardiothoracic Surgery, New York Medical College, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, United States of America
Usha Krishnan*
Affiliation:
Department of Pediatric Cardiology, New York Medical College, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, United States of America Department of Pediatric Cardiology, Children's Hospital of NY Presbyterian, Columbia University Medical Center, New York, United States of America
*
Correspondence to: Dr U. Krishnan, MD, Pediatric Cardiology, 3959 Broadway, 2 North, Suite 255, Columbia University Medical Center, New York, New York 10032, United States of America. Tel: 212 305 4436; Fax: 212 342 1443; E-mail: usk1@columbia.edu

Abstract

Aneurysm of the sinus of Valsalva is an uncommon congenital lesion rarely reported in children. Unruptured aneurysms commonly go undiagnosed until a rupture has occurred. Usually, ruptured sinus of Valsalva presents with cardiac failure. There may be a history of trauma or infective endocarditis preceding the rupture. Asymptomatic paediatric presentation of ruptured sinus of Valsalva is rare. We discuss the cases of two children who presented with a murmur and were diagnosed with ruptured sinus of Valsalva. This unusual presentation in children highlights the importance of careful routine physical examinations and the evaluation of new murmurs. The Okham's razor principle states that “when you hear hoofbeats – think horses not zebras”. Sometimes, it is important to think beyond the usual in medicine, to avoid missing lesions that, if left untreated, could lead to adverse outcomes.

Type
Brief Reports
Copyright
Copyright © Cambridge University Press 2011

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