Severe aortic regurgitation from a ruptured Valsalva aneurysm is rare. We report on a 28-year-old male patient was presented with a Ruptured Sinus of Valsalva Aneurysm by Transthoracic echocardiography. Intraoperatively, a perforated aortic lobe was found to have caused specific aortic regurgitant flow. The patient underwent successful surgery. Intraoperative transesophageal echocardiography provides important information for the surgical plan.