Giant ruptured sinus of Valsalva aneurysm: diagnosis on echocardiography

A giant ruptured sinus of Valsalva aneurysm was diagnosed on transthoracic and subsequent transesophageal echocardiography, in a 45-year-old man who presented with gradual onset shortness of breath. Although the initial presentation was insidious, he later rapidly deteriorated. We discuss the unusual clinical course in a patient with such a large aneurysm and discuss the likely reasons.