Ruptured Valsalva sinus aneurysm.
Sinus of Valsalva aneurysm appears as a saccular outpouching from the sinus of Valsalva. When it ruptures, it most commonly ruptures into the right ventricle, followed by the right atrium. The aorto-cardiac shunt (left to right shunt) can lead to insidious heart failure.
Extracardiac rupture is rare and can lead to cardiac tamponade, which carries a higher mortality rate. The treatment option is cardiopulmonary bypass surgery.