An 82-year-old male with of a history of hypertension presented to the emergency department with complaints of intermittent palpitations. Electrocardiogram results showed monomorphic ventricular tachycardia, which responded to intravenous amiodarone (A). The echocardiogram revealed an 8 × 7-cm right sinus of Valsalva aneurysm that was causing compression of the right ventricular outflow tract (B and C,Online Videos 1 and 2) along with moderate to severe aortic regurgitation (D,Online Video 3). The patient was offered surgery, but he refused any further invasive measures. The remaining course of his stay was uneventful, and he continued to do well at the 1-year follow-up.

Sinus of Valsalva aneurysms are extremely rare lesions that are caused by separation of the aortic media from the aortic annulus. They most commonly originate from the right sinus and present with symptoms related to either compression of the adjacent structures or intracardiac shunting from their rupture.