The echocardiographic features of ruptured sinus of valsalva aneurysm were described in a 32-year-old man. The diagnosis was established deductively using the precordial, subxiphoidal and suprasternal approach. Despite careful scanning no discontinuity between the anterior aortic wall and the interventricular septum could be observed, thus demonstrating directly the perforated part of the aneurysm. However, the abnormal motion pattern of the tricuspid valve on the subxiphoid echocardiogram and the enlarged right ventricular cavity suggested involvement of the right ventricle. Pre- and postoperative findings were compared.