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An 82-year-old man presented with severe exertional breathlessness to the outpatient clinic. Previous medical history included hypertension and transient ischaemic attack. During routine workup, transthoracic echocardiography was performed. A large defect (*) in the anterior wall of the aortic sinus of Valsalva was identified (figure 1A) which extended into a cavity containing spontaneous echo-contrast (see online supplementary data video S1). Further imaging by CT with three-dimensional reconstruction (figure 1B,C) and cardiac magnetic …
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