The correct answer is: c. Ruptured sinus of valsalva aneurysm

First pass perfusion demonstrated its communication with the aortic root but no extravasation of contrast into the pericardial space. There was also a small anterior transmural scar (Figure C, Video 1). During cardiac surgery a small, closed, dimple deep in a recess immediately above the annulus was visualized not needing further intervention (Figure B Follow Up CT arrow). On Follow Up CMR the structure did not show first pass perfusion and appeared to be thrombosed (Figure D, Figure E, Video 2). Diagnosis of a ruptured small aneurysm of the Sinus of Valsalva with extraaortic haematoma probably compromising a small branch coronary artery was made.