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A sinus of Valsalva aneurysm is a rare defect that is usually asymptomatic. We report a sinus of Valsalva aneurysm arising from the left coronary sinus with compression of the left main coronary artery in a 56-year-old man who presented with worsening chest pain. Coronary imaging revealed a 4.6-cm sinus of Valsalva aneurysm with compression of the left main stem, left anterior descending, and proximal circumflex arteries. He underwent aortic root and ascending aortic replacement. Large sinus of Valsalva aneurysms can be life-threatening
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