'It's awesome. What a great week, what a great finish,' Sorenstam exclaimed. 'I want to congratulate Pat on great competition and good playing. Wow, this is fantastic.'
Meg Mallon went 13 years between her wins in 1991 and 2004, where she beat Sorenstam by two shots with a Sunday 65.
'When I came out early and won my first tournament, the U.S. Open, then I won back-to-back and I thought wow I can do this. Now it's been 10 years. It's been a long road and on the way I've learned a lot,' said Sorenstam, who earned $560,000 for the win. 'This week obviously means a lot to me. The way I came back, with my season being so up-and-down, to win the Open is pretty ironic.'
Hurst three-putted for bogey on the first at Newport Country Club and three-putted for double bogey on the sixth en route to a 4-over 75.
This was the third women's major this season to end in a playoff. Karrie Webb downed Lorena Ochoa on the first extra hole at the Kraft Nabisco Championship and Se Ri Pak bested Webb at the LPGA Championship, also on the first hole.
It also marked the 10th playoff in U.S. Women's Open history, and the first since Hilary Lunke was victorious in 2003.
At the start of the week, many thought a Monday finish would be needed after heavy fog never lifted off the course on Thursday and not one shot was struck all day.
However, the players managed to complete both the third and fourth rounds on Sunday to set up the 18-hole Monday playoff.
Sorenstam took control of the playoff quickly with a 6-foot birdie putt on the first. Hurst's approach shot at the first spun hard back off the front edge. She three-putted from the fringe for bogey to quickly fall two back.
The 35-year-old Sorenstam pushed her lead to three strokes with a 6-foot birdie putt on the par-4 third. The duo matched pars on the next two holes.
Hurst, the 1998 Kraft Nabisco Championship winner, drove her tee shot under the lip of a fairway bunker at the par-4 sixth. She pitched out with a sand wedge, but pulled the shot into the left rough.
The 37-year-old Hurst knocked her third shot to 25 feet. She rolled her par putt within 3 feet, but lipped out that short putt. The double bogey dropped Hurst four behind Sorenstam.
The women's world No. 1 had trouble of her own on the sixth. Sorenstam came up short and right of the green in a bunker. She blasted on, but two-putted for bogey from over 50 feet out to slide to minus-1.
Hurst missed the green left at the ninth and was unable to save par from there. The bogey dropped her to plus-4, five back of Sorenstam.
Sorenstam extended that lead to six strokes with a 10-foot birdie putt on the 12th. She gave that stroke right back with a bogey on 13.
However, Hurst could not take advantage. She missed birdie putts from inside 16 feet on 11 and 12, then got up and down for par on 13.
The duo matched pars over the next four holes as Sorenstam cruised down the stretch hitting fairways and greens. Sorenstam hit the final eight fairways and two-putted for par on the last five holes.
'I've been trying so hard to treat this as any other day. I think I've been talking to myself so many times, that if somebody saw me they'd think I was weird,' Sorenstam joked. 'But I kept telling myself to play your game, it's good enough, focus on what you have to do, don't think too much about the surroundings. This is what you want, here's a chance. I just kept telling myself that over and over.'
Hurst, who never got as hot with her putter as she has been in the past, drained a long birdie putt on the last for her only birdie of the day.
'I kept pushing and didn't make any putts out there and that was probably what kept me back,' admitted Hurst, who dropped to 0-4 in her career in playoffs. 'If I could have made a couple of putts out there today, maybe it would have been a little closer and would have put a little pressure on her.
'She played great and was steady. She was down the middle and on the greens and made some putts here and there. Emotionally, I am spent.'
Michelle Wie had a share of the lead Sunday until a bogey at the 13th. She finished with a 2-over 73 and a share of third place with Pak (69) and Stacy Prammanasudh (72) at 2-over-par 286.
Two-time U.S. Women's Open winner Juli Inkster also had a piece of the lead on Sunday, but three bogeys over her final 10 holes dropped her to sixth place. She carded a 2-over 73 in the final round and ended at plus-three.
Brittany Lincicome, who shared the lead entering the final round with Wie and Sorenstam, struggled to a 7-over 78 in the final round and finished alone in seventh at plus-seven. Rachel Hetherington (73) and Shi Hyun Ahn (76) tied for eighth place at 8-over-par 292.
Amateurs Amanda Blumenherst (73) and Jane Park (76) tied for 10th place with Jee Young Lee (77), Patricia Meunier-Lebouc (75), Sophie Gustafson (78) and Young Kim (74). That group came in at 9-over-par 293.