A 45-year-old male who underwent aortic valve replacement 3 years ago was transferred to our institution on January 13, 2012. He presented with progressive dyspnea, palpitation, orthopnea, abdominal distension and lower limb edema, which developed 1 month after aortic valve replacement. Despite the use of excellent medical therapy, the patient had a deteriorating cardiac function. Cardiac auscultation revealed a grade 3/6 systolic murmur at the right upper sternal border. Chest radiograph showed bilateral pleural effusion, diffuse interstitial markings, and a hugely enlarged heart shadow with a spherical configuration on its right side. Computed tomography angiography (CTA) showed that an aortic pseudoaneurysm originated from an orifice (about 6 mm in diameter) in the ascending aorta. Transthoracic echocardiography (TTE) revealed the giant aortic pseudoaneurysm fistulating into the right atrium (Fig. 1). The fistula measured 10 mm at the diameter and the pseudoaneurysmmeasured 80 × 65 mm at the maximal echocardiographic diameters. Cardiac enlargement showed that the left atrial volume was 72 ml, the left ventricular volume was 118 ml and the right atrial volume was 96 ml with severe tricuspid regurgitation (12 ml). The ejection fraction was 40%. He was considered to be a high-risk candidate for repeat surgery and referred for percutaneous closure on January 15, 2012. An aortic angiogram was performed to confirm the presence of the giant pseudoaneurysm (online Video 1). A modified muscular occluder (Shanghai Shape Memory Alloy Ltd., China) similar to the Amplatzer occluder, was used in this procedure. It was made of a 0.005-in nitinol wire mesh with fabric inside and approved by the State Food and Drug Administration (SFDA) of China in 2003 (Fig. 2). The occluder was delivered via the right femoral artery using a 10French delivery sheath. Final aortogram revealed that there was no residual flow into the pseudoaneurysm and the occluder was wellpositioned (online Videos 2 and 3). The procedure was well tolerated by the patient and completely without immediate complications. Post-operative day 3, TTE demonstrated no residual flow across the pseudoaneurysm. CTA revealed that the occluder was well fixed into the neck of pseudoaneurysm (Fig. 3). At one-year follow-up, chest radiograph showed that the size of the pseudoaneurysm gradually decreased (Fig. 4). TTE showed no residual flow to the pseudoaneurysm, with an ejection fraction of 62%. The left atrial volume was 66 ml, the right atrial volume was 91 ml, and the right atrial volume had decreased from 118 ml to 97 ml. The volume of tricuspid regurgitation had decreased from 12 ml to 2 ml. Furthermore, the patient had no serious health problems and enjoyed a good quality of life during the follow-up.