A 30-year-old man with a structurally normal heart was referred to us with a 2-year history of recurrent episodes of rapid paroxysmal palpitations. A few episodes required hospitalization and were terminated with intravenous diltiazem. During electrophysiology (EP) study done twice before in other hospitals, the patient was diagnosed as typical atrioventricular nodal reentrant tachycardia (AVNRT) and underwent radiofrequency ablation of the slow pathway. However, the episodes recurred.  Because of the patient’s persistent symptoms, an EP study was performed again. Tachycardia was easily induced using atrial extrastimuli, ventricular extrastimuli and with rapid atrial pacing.

Here we present a young asymptomatic male incidentally diagnosed to have aortic regurgitation (AR). The patient had a history of a blunt trauma to the thorax two years back but did never have any symptoms. Transthoracic echocardiography showed a moderately dilated left ventricle with normal systolic function and severe AR with normal nondilated aortic root and tri-leaflet aortic valve. To diagnose the etiology of the AR a trans-esophageal echocardiogram (TEE) was done, which revealed a perforation in the non-adjacent leaflet (NAL) and confirmed severe AR with two AR jets being clearly visualised, one through the point of incomplete coaptation and other one through the perforated area in the NAL. The patient was treated with aortic valve replacement and was doing well on follow-up.