Objective: Analysis of three cases in which the clinical diagnosis was ruptured sinus of Valsalva aneurysm (RSVA) from left coronary sinus, combined with similar cases in the literature, to summarize the etiology of RSVA. Methods: Retrospective analysis of three cases of RSVA diagnosed in our hospital from 2009 to 2021. Their general condition, examination and treatment were analyzed, and the etiology of the sinus of Valsalva aneurysm (SVA) was summarized in relation to similar cases reported in the literature. Results: All three cases were diagnosed as RSVA from left coronary sinus with a clear etiology of congenital SVA, Behcet’s disease and infective endocarditis, respectively. They all underwent successful surgical treatment. In the literature, there were 12 cases of SVA from left coronary sinus of definite etiology, 10 of which ruptured. Conclusions: SVA from left coronary sinus is a rare disease with a complex etiology, and RSVA is one of the most serious complications of SVA. Exploring the etiology of SVA will help to prevent the serious complications of RSVA by targeting the etiology for treatment and timely surgical intervention.