Aortic sinus aneurysms are also called congenital aortic sinus aneurysms when the aortic root is defective and the aortic sinus wall becomes thin and aneurysmatically dilated under aortic pressure. If the aneurysm penetrates into the adjacent cardiac chambers, pericardium or pulmonary artery and produces an intra-cardiac shunt, it is called an aortic sinus aneurysm rupture. Depending on the location of the aortic sinus aneurysm, aortic sinus aneurysms originating from the right coronary sinus may rupture into the right ventricular outflow tract under the pulmonary valve, under the supraventricular ridge, and around the membranous septum; those originating from non-coronary sinuses mostly rupture into the right atrium and a few into the right ventricle; those originating from the left coronary sinus may rupture into the left atrium, left ventricle, or pericardial cavity. Patients with sinus aneurysms are often associated with other congenital heart diseases, such as ventricular septal defect, aortic valve insufficiency, patent ductus arteriosus, atrial septal defect, and aortic constriction. Most sinus aneurysms in patients with a combined ventricular septal defect originate in the right coronary sinus. Many patients with aortic sinus aneurysms have combined aortic valve insufficiency, which is caused by the loss of subvalvular support and downward prolapse of the right coronary valve in the aorta due to a pulmonary subvalvular septal defect, and the formation of sinus aneurysms can further aggravate leaflet prolapse and insufficiency. Sinus aneurysms are usually asymptomatic when they are not ruptured, but in a few cases they may manifest as obstruction or compression when they are too large. When certain factors, such as strenuous activity or trauma, cause a sudden rise in intra-aortic pressure, the sinus tumor may rupture into the adjacent cardiac cavity and cause acute cardiac insufficiency, and the clinical symptoms often vary depending on the site of rupture into the cardiac cavity, the size of the rupture, and the combined malformation. The typical symptoms of sinus tumor rupture are sudden severe chest pain with palpitations, dyspnea, and even acute heart failure, which is similar to acute angina but does not radiate to the neck, shoulders, or back. After a short period of rest, the pain and shortness of breath may disappear and return to normal. Thereafter, patients often feel weak, dizzy, panic, shortness of breath, swelling of the lower limbs may intermittently aggravate and affect work, and gradually lose labor endurance. Few patients may be asymptomatic although their hearts have murmurs for a longer period of time. Systolic tremor can be felt between the third and fourth ribs at the left edge of the sternum, and a double-phase continuous loud murmur can be heard, with a hyperactive second pulmonary valve sound. Peripheral vascular signs such as widened pulse pressure, watery pulse, and positive capillary pulsation sign are often present, and angina pectoris or myocardial infarction may occur in those with left coronary artery compression. Generally, the diagnosis is clear based on the patient’s clinical manifestations, physical examination, and special tests (cardiac ultrasound, chest radiograph, electrocardiogram). Usually, aortic sinus aneurysm should be operated as soon as it is clearly diagnosed, especially in patients with ruptured aortic sinus aneurysm.