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Localized aneurysms of the sinus of Valsalva are extremely rare. They may be congenital or acquired (as a consequence of trauma, degeneration, inflammation or infection). A 74-year-old man with hypertension, type 2 diabetes mellitus and dyslipidemia, was admitted in the emergency room after an episode of retrosternal chest pain and shortness of breath. Physical exam was unremarkable. The ECG showed ischemic T waves from V1 to V5 and the peak troponin I level was 0.5 ng/ml. He was referred for coronary angiography, which demonstrated as unique pathologic finding left main extrinsic compression from an ovoid-shaped structure with turbulent flow of dye inside (Fig. 1; SVA -sinus of Valsalva aneurysm, LM -left main). Magnetic

Unruptured sinus of Valsalva aneurysm presenting as NSTEMI