We present a case of classical Austrian syndrome in a 55-year-old man with a history of alcoholism. The rapid destruction in aortic valve cusps caused perforations with severe aortic insufficiency, acute pulmonary edema, and determined an urgent aortic valve substitution with good postoperative evolution. The review of the literature suggests cardiac surgery in this syndrome to improve the poor survival with conservative treatment. We recommend early surgery in these cases because of the fast impairment of the patient and valvular tissue destruction detected in intraoperatory examination.