Sinus of Valsalva aneurysms (SOVA) are rare conditions in which a portion of the aortic root dilates due to weakness of the aortic wall, which can eventually lead to rupture, leading to a shunt from the aorta into any one of the cardiac chambers. Some patients can present asymptomatically and are diagnosed incidentally, while others can present with precipitous courses with symptoms of chest pain, palpitations and heart failure. When left untreated, these patients have poor prognosis.

A total of six patients are presented in this case series. These patients were seen in a national tertiary hospital from 2018 to 2024. The patients had varied characteristics, with ages ranging from 24-57 years old. Most of the patients were males. The presenting symptoms are also varied, with dyspnea being the most common symptom and a murmur being the most common sign. The most commonly involved sinus was the right coronary sinus draining into the right ventricle, with half of the patients presenting with concomitant ventricular septal defects. Five out of the six patients underwent successful open repair of their ruptured SOVAs and were eventually discharged.

Early identification of the cardiac lesion is important to clinch the diagnosis and plan for eventual definitive management. Imaging studies such as transthoracic echocardiogram are needed to visualize the defect, which is classically described as a windsock deformity. Transesophageal echocardiography may present clearer images to assess the anatomy better preoperatively. Medical management is usually done to bridge the patient to more definitive therapy, either through endovascular closure if the anatomy permits it or through surgical repair. Urgent and timely repair is needed to ensure improved survival in these patients.