2D echocardiogram shows the large thrombosed sinus of Valsalva aneurysm (blue arrow). Report: Echocardiogram was done showing no change in ejection fraction from previous studies (55%) with left ventricle concentric hypertrophy in addition to the prosthetic aortic valve, dilated left atrium, a very large and thrombosed sinus of Valsalva aneurysm, mildly dilated inferior vena cava, a pacemaker lead in the right ventricle, and a catheter/pacemaker lead seen in the RA cavity. It was noted that the right ventricle systolic pressure was elevated at 40–50 mmHg.