Introduction Perforated sinus of Valsalva (PSOV) aneurysm, a well recognized entity, is usually congenital, occurs in adolescence to early childhood, and very rarely such communication has been observed following infective endocarditis or aortic valve replacement.1,2 It has been described in medical literature since 1840 and may occur as an isolated defect or with other congenital cardiac anomalies. The incidence varies from 0.14 to 3.5% of all congenital anomalies.3,4 It is five times more prevalent in Asian countries than the Western population, and three times more common in males.5