PMC4939254_01
Transesophageal echocardiography in the mid-esophageal view, demonstrating a linear dissection flap originating from the non-coronary sinus of Valsalva
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F1
Also, there was early diastolic collapse of the right ventricular outflow tract, consistent with tamponade physiology (Figure 1). Moreover, aortic valve annulus diameter was 2.36 cm, Valsalva sinus diameter was 3.94 cm, and sinotubular junction diameter was 2.96 cm (Figure 1). TEE demonstrated a linear dissection flap in the non-coronary sinus of Valsalva (Figure 1) with protrusion into the aortic valve, leading to the maladaptation of the aortic valve and subsequent severe AR. 
PMC4939254_02
Electrocardiogram at admission, showing sinus rhythm, normal axis, QS-waves in leads II and aVF, and inverted T wave in aVF
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F2
Transesophageal echocardiography in the mid-esophageal view, showing severe aortic regurgitation (AR) and a dilated ascending aorta
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F3
AR and a dilated ascending aorta (5 cm) (Figure 3). Also, the aortic valve annulus diameter was 2.4 cm, Valsalva sinus diameter was 4 cm, and sinotubular junction diameter was 4 cm.
Transesophageal echocardiography in the mid-esophageal view, showing a linear dissection flap in the non-coronary sinus of Valsalva
JTHC-11-34-g004.jpg
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F4
Similar to the previous case, TEE showed a linear dissection flap in the non-coronary sinus of Valsalva with protrusion into the aortic valve, leading to severe AR (Figure 4).