A 29-year-old man was admitted to our outpatient clinic with exertional dyspnea. Transesophageal echocardiography (TEE) revealed a ruptured sinus of Valsalva aneurysm into the right ventricle. Real time three-dimensional (3D) TEE, used to visualize the relationship between the rupture, the aortic valve, and the right ventricle, revealed the precise shape, size, and location of the defect. The defect was closed using a 16/10 mm Amplatzer duct occluder under real time 3DTEE guidance. 3DTEE provided more accurate delineation of the defect location and orientation than other imaging techniques and may aid in the selection of an appropriate device for closure.