Ruptured sinus of Valsalva aneurysm (RSOV), a rare but well- recognized clinical entity, is invariably a form of left-to-right shunt due to rupture into right-sided chambers. It causes profound hemodynamic effects, especially when the rupture is acute. Like most other left-to-right shunts, it was only a matter of time before this rare defect also became amenable to transcatheter closure (TCC). Since the first report of TCC of RSOV by Cullen et al. in 1994 using the Rashkind umbrella, in recent times, there have been a spate of case reports, brief communications and interesting case presentations at interventional meetings using the much user-friendly and effective Amplatzer devices. Given the preponderance of RSOV in Asians compared with the Western population, it was only natural that the first series of eight patients was reported from India by Arora et al. In this issue of the journal, Sen et al. from India report another series of eight patients performed in a short span of 4 years a commendable effort. Encouraged by the excellent 1-year outcome of TCC of RSOV in our first patient, a post-CABG, critically-ill patient, we too have attempted TCC of RSVA in 17 patients between July 2004 and Jan 2009. Traditionally, surgical closure has been the mainstay of therapy for RSOV, with an operative mortality of <5 %. Before offering TCC of RSOV as an acceptable alternative to surgery, we need to ponder over (i) the criteria for case and device selection, (ii) the nuances of the technique and (iii) the possible complications.