Ruptured Sinus of Valsalva Aneurysm Presenting With Aorto–Right Atrial Fistula

BACKGROUND: Sinus of Valsalva aneurysms (SVAs) are rare cardiac anomalies that often remain silent until rupture occurs. Prompt recognition and repair is essential, as untreated ruptured SVAs can lead to progressive right heart failure and early mortality. CASE SUMMARY: A 26-year-old woman with a ruptured SVA and aorto-right atrial fistula underwent definitive surgical repair after failed transcatheter closure, with excellent postoperative recovery. DISCUSSION: Ruptured SVAs are rare and can present with subtle symptoms that can mimic other pathologies. Astute clinical examination, multimodal imaging, and timely surgical management all assist in ensuring excellent long-term outcomes. TAKE-HOME MESSAGE: Early recognition and meticulous perioperative management of ruptured SVAs are the keys to ensuring excellent long-term outcomes.