Ruptured Sinus of Valsalva (RSOV) is very rare in paediatric age group, 3rd decade being the usual presentation age. Patient may present with asymptomatic murmur to cardiogenic shock and fatal outcomes. High degree of suspicion and expertise is required to confirm or rule out diagnosis. Here we have reported a case of RSOV in 6-year-old boy who presented with features of hyperdynamic circulation. Transesophageal Echocardiography (TEE) images are shown here which confirm the presence of RSOV and rule out other close differentials. Here the right coronary cusp is involved, and colour jet is clearly visible to have communication between aorta and right atrium. Transthoracic echocardiogram cannot always differentiate between RSOV and Ventricular Septal Defect (VSD). TEE can clearly demonstrate the aorto-cardiac communication and helps in proper diagnosis and appropriate management Figure 1 and Video 1.
Figure 1: Transesophageal Echocardiography (TEE) image.