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A 67-year-old man with hypertension, dyslipidemia, chronic kidney disease, and coronary calcifications presented with progressive exertional dyspnea in the setting of mild mixed aortic valve disease. Pharmacologic nuclear stress testing showed no ischemia. Transthoracic echocardiography (TTE) was limited but showed normal chamber size and function, moderate aortic regurgitation, and mild-to-moderate aortic stenosis.

Transesophageal echocardiography (TEE) revealed leaflet sclerosis, systolic doming, and commissural fusion between the noncoronary and right cusps, as well as the right and left cusps (Figure 1A-B; Videos 1-2). 2D and 3D multiplanar reconstruction confirmed a single-commissure unicuspid valve (Figure 1A-D; Video 3), with moderate central regurgitation (Figure 1E; Video 4) and mild stenosis (valve area 1.8 cm?2;). A proximal ascending aortic aneurysm was visualized, measuring 4.3 cm (Figure 1F). A CT scan is pending to further assess the aortic root aneurysm and valve morphology.

Keywords: Unicuspid aortic valve; Mixed aortic disease; Aortic aneurysm; 3D TEE