A Five-Leaf Clover or an Exceptionally Rare Cause of Severe Aortic Insufficiency?

      A 56-YEAR-old, 68- kg, 165- cm woman with a history of Crohn's disease presented to the authors’ institution with dyspnea and exercise intolerance of several months’ duration. More recently, her symptoms had progressed to occasional dyspnea at rest. She denied fever, chills, chest pain or pressure, palpitations, orthopnea, paroxysmal nocturnal dyspnea, syncope, and peripheral swelling. The physical examination was notable for a grade III of VI holodiastolic murmur. The electrocardiogram and laboratory analysis were noncontributory. Transesophageal echocardiography (TEE) was performed as part of the diagnostic evaluation and the following images were obtained (Fig. 1-4; Videos 1-4). What is the diagnosis?
      Fig 1
      Fig 1A midesophageal aortic valve short-axis transesophageal echocardiography view.

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