This case highlights the clinical usefulness of three-dimensional (3D) echocardiography. The diagnosis of inter-ventricular septal defect associated with aortic regurgitation has been performed in a 50-year-old man using 3D echocardiography. This advanced echocardiography could accurately reproduce the anatomy of the defect and provide further insights in the mechanisms of aortic regurgitation showing an unusual non-coronary cusp prolapse. The routinely use of 3D echocardiography in clinics might allow a better characterization of cardiac anatomy, especially of aortic valve disorders.