A 57-year-old man with a history of prosthetic aortic valve and supracorona
ry ascending aortic replacement presented with a 9.8 cm Sinuses of Valsalva
e aneurysm ruptured into the left upper pulmonary vein leading to massive p
ulmonary hemorrhage due to acute rupture of small pulmonary veins. Prosthet
ic graft replacement of the aneurysm and reconstruction of the atrial roof
and left upper pulmonary vein was performed. Inhaled nitric oxide reversed
treatment-refractory hypoxemia following massive small pulmonary vein traum
a.