Aortic valve perforation due to a penetrating cardiac injury is extremely rare, especially with an associated shunt between the right ventricle and the aortic valve. We report here the case of an 18-year-old male, who after suffering a chest stab injury, was seen at another institution where he underwent an emergency left anterolateral thoracotomy and right ventricular suture. During the following 30 days, his course was torpid, complicated by a ventilator-associated pneumonia and heart failure with acute pulmonary edema. Workup confirmed the presence of an acute aortic regurgitation due to perforation of the right coronary leaflet with an interventricular shunt. After implementing appropriate medical treatment, the valve was replaced with a mechanical prosthesis and the shunt was closed with an autologous pericardial patch.