Background: Ruptured aneurysms of sinus of Valsalva are defects of the aortic media, which are uncommon yet present concomitantly with either ventricular septal defect, aortic insufficiency or both. Here, we analyse retrospectively outcomes of patients operated on in the last two decades. Patients and Methods: 151 cases of ruptured aneurysms of sinuses of Valsalva were treated here between January 2000 and December 2020. The majority (96%) arose from the right coronary sinus. The right ventricular outflow was the most common site of rupture (56.2%). Ventricular septal defect was associated in 24 patients (16%) all of whom had ruptured right sinus, of which 8 (33%) were of subpulmonic subtype. Aortic incompetence was found in 45 patients (43.3%). Elective surgery was offered to 78 patients (51.6%), while the rest had defects closed by interventional devices. Surgical conversion for device embolization occurred in 12 patients (7.94 %). The defect was closed through the aortic root in 13 patients (14.4% of 90) and employing the bicameral technique (root and ruptured chamber) in the remaining 87 patients. 18 patients (20%) underwent aortic valve repair while 5 (5.5%) underwent aortic valve replacement. Results: We had no hospital deaths, however 4 operated patients (2.6%) had comorbidities. Follow‐up ranged from 1 to 20 years (mean 13 ± 5). There were 3 deaths in this period, and among the majority, quality of life was uneventful. Conclusion: Surgical correction for ruptured aneurysms of Valsalva provides prudent results and must be the preferred modality of treatment in acute and chronic presentation.