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Continuous murmur following chest trauma.

A 25-year-old asymptomatic man was hospitalized for heroin detoxification. Five years previously he had been stabbed in the left side of the chest and during emergency surgery a laceration of the right ventricle near the base of the pulmonary artery was repaired. No murmurs were described at that time. On physical examination the blood pressure was 112/78 mm Hg. At the upper left sternal border there was a grade 3/6 holosystolic murmur and a grade 3/6 decrescendo long diastolic murmur. There were no palpable thrills. Chest roentgenogram, ECG, and M-mode echocardiogram all were normal. A two-dimensional echocardiogram is shown in Fig 1. What is your diagnosis? The two-dimensional echocardiogram (Fig 1) shows an aneurysm of the right sinus of Valsalva. The sagittal or long-axis view illustrated in the left panel shows aneurysmal protrusion of the anterior aortic wall into the right ventricular outflow tract. This abnormality is located just distal