Sinus of Valsalva aneurysms most commonly rupture into which structure(s)?

Sinus of Valsalva aneurysms typically rupture into the right heart chambers, most commonly the right atrium or right ventricle. This creates a left-to-right shunt and can lead to volume overload and heart failure if not treated.

Rupture into the pericardial space is less common and may cause tamponade. Rupture into the left atrium or coronary sinus is rare.

This clinical detail is described in the "Textbook of Clinical Echocardiography, 6e", Chapter on Aortic Root Pathology and Sinus of Valsalva Aneurysms【20:420-425†Textbook of Clinical Echocardiography】.