Acute Heart Failure Caused by a Ruptured Sinus of Valsalva Aneurysm: A Rare Presentation.

Sinus of valsalva aneurysm (SOV) is a rare aortic pathology that may be congenital or acquired and often remains clinically silent until rupture. When rupture occurs, it can lead to acute and life-threatening hemodynamic deterioration. We report the case of a 65-year-old male who presented with sudden-onset dyspnea and peripheral edema and was diagnosed with acute heart failure secondary to a ruptured SOV. Transthoracic and transesophageal echocardiography, followed by computed tomography angiography, demonstrated a ruptured aneurysm originating from the noncoronary sinus with significant left-to-right shunting. Owing to extensive aortic root involvement, the patient underwent a Bentall procedure with successful clinical outcome. This case highlights the importance of considering ruptured SOV in the differential diagnosis of acute heart failure, particularly in elderly patients, and underscores the critical role of comprehensive imaging and timely surgical intervention in guiding optimal management.