Large, Isolated Aortic Valve Aneurysm

36-year-old man presented with a 3-month history of palpitations, dizziness, and intermittent fever, for which antibiotic therapy had been prescribed. Cardiac auscultation revealed a 3/6 holodiastolic murmur at the left upper sternal border and no evidence of other abnormal results. The patient had no history of valvular endocarditis or connective-tissue abnormalities. Laboratory testing revealed a white blood cell count of 9.53 × 10 9 /L and an erythrocyte sedimentation rate of 14 mm/hr. Blood cultures, taken 3 times, were negative. Two-dimensional transthoracic echocardiography (TTE) showed left ventricular enlargement and a large aneurysm of the right coronary cusp of the aortic valve (Fig. 1). Real-time 3-dimensional (3D) TTE showed that a pocket-like lesion protruded into the left ventricular outflow tract in diastole and disappeared in systole when viewed from the left ventricle (Fig. 2). Two-dimensional and color-flow Doppler transesophageal echocardiography (TEE) showed the aneurysm, severe aortic regurgitation, and no evidence of vegetation or perforation (Fig. 3). Real-time 3D TEE showed an aneurysm of the right coronary