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A 29-year-old patient came to our hospital with worsening exertional dyspnea of three months duration. He also complained of cough since five months, palpitations, swollen neck veins, feet and easy fatigability since three months. Palpitations were precipitated by exertion and relieved on taking rest. Patient gave history of severe limitation of physical activity.On physical examination, patient was in respiratory distress with a rate of 30 per minute. He had a regular bounding pulse of 116 beats/ minute and blood pressure of 115/50 mm Hg. He had an elevated jugular venous pressure and pitting ankle oedema. On auscultation, his lungs were clear. Precordial examination revealed a grade 4/6 continuous murmur best heard over left sternal border. Chest X-ray revealed cardiomegaly and pulmonary venous congestion. ECG showed sinus tachycardia. Transthoracic echocardiography of patient showed a membranous out pouching of the right coronary cusp (RCC) into the right ventricle with 8.0 mm width perforation. Coronary angiogram showed normal study [Table/ Fig-1]. A diagnosis of ruptured aneurysm of right sinus of valsalva was confirmed and patient was managed with diuretics, ACE inhibitors, digoxin, antibiotics and planned for surgery.Patient was premedicated with midazolam and induction of anaesthesia was performed in a propped up position. General anaesthesia was maintained with Isoflurane, Vecuronium, Fentanyl. Intraoperative monitoring with ECG, pulseoximetry, capnography, temperature, urine output was done. Invasive arterial blood pressure monitoring was done after right radial artery cannulation and CVP monitoring by right internal jugular vein cannulation. Cardiopulmonary bypass (CPB) was instituted after securing cannulas for the aorta, superior vena cava, inferior vena cava. Pericardial patch was used to repair rupture sinus of valsalva and also closure of subpulmonic ventricular septal defect. Patient was transferred to ICU intubated and extubated six hours later. On postoperative day-1, chest tubes were removed and patient discharged on day-7. Patient was asymptomatic on the first follow up after discharge. DisCussionA ruptured sinus of valsalva aneurysm is rare. It is usually congenital in origin. Congenital aneurysms result from localized weakness of elastic lamina at the junction of aortic media and annulus fibrosus. They are usually seen in patients with Marfans and Ehlers-Danlos syndrome [1]. Acquired aneurysms are caused by infectious diseases like bacterial-endocarditis, syphilis, tuberculosis. Degenerating conditions like atherosclerosis, cystic medial necrosis, injury from deceleration trauma are also associated with acquired ASOV [2]. The most common cardiac anomalies with ASOV are ventricular septal defects (30-60%), aortic insufficiency (20-30%), bicuspid aortic valve (10%) and coronary anomalies [3].The sinuses are named according to their relationship with the coronaries. i.e. the right coronary sinus, the left coronary sinus and the non-coronary sinus [4]. Among the congenital sinus of valsalva an...

31-year-old female with hypersensitivity to local anesthetics and neuromuscular blocking agents presented for emergency Cesarean section. We successfully performed I-gel-assisted tracheal intubation without using neuromuscular blockers. We believe this method would be helpful in selected situations.