This case report is about a 24-year-old lady, labeled case of ventricular septal defect since birth, who presented with sudden onset of chest pain and palpitation followed by acute pulmonary edema. She was found to have clinical cardiomegaly, biventricular impulse, pansystolic murmur of ventricular septal defect with continuous murmur at the right lower sternal border. Electrocadiogram revealed frequent ventricular premature beat and chest skiagram revealed cardiomegaly with pulmonary venous congestion. Transthoracic color doppler echocardiography revealed ruptured non coronary sinus of valsalva to right ventricle with large left to right shunt, perimembraneous sub aortic ventricular septal defect with left to right shunt and prolapse of right coronary cusp with mild aortic regurgitation and good left ventricular systolic function. She underwent corrective surgery of ruptured sinus of valsalva and ventricular septal defect and aortic valve replacement.
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