A 59-year-old male patient was referred for echocardiography because of progressive shortness of breath on exertion of one-month duration. The patient was not in distress and vital signs were normal. Cardiac examination and auscultation revealed displacement of the apical impulse to the 6th intercostal space and a long continuous murmur was heard along the lower sternum accompanied by a thrill. Figures show the TEE and Doppler examination. The 4 chamber view at 0 degree (Panel A) shows an aneurysmal sac protruding into the right atrium from the aortic root (open white arrows). Green arrows indicate tricuspid valve. Color Doppler shows turbulent flow (solid white arrows) from the aorta through the pouch into the right atrium (Panel B). The same saccular-like structure in the RA is seen in short axis view at 59 degrees with turbulent flow by color Doppler (Panels C & D). Interrogation by CW Doppler revealed continuous turbulent flow in systole and diastole (Panel E).

From the Echocardiography Laboratory, Cardiology & Cardiovascular Surgery Department, Hamad Medical Corporation, Doha, Qatar