A 33-year-old man presented to the hospital with progressive dyspnea and palpitations. He had a history of scoliosis 14 years ago, requiring spinal fusion surgery. Physical examination revealed mar-fanoid habit and irregular heartbeats with a holosys-tolic murmur of mitral regurgitation and a diastolic murmur of aortic regurgitation. Electrocardiography showed atrial fibrillation and chest radiography revealed a widened mediastinum with an enlarged cardiac silhouette (Figure 1a). Echocardiogram found dilatation of the mitral annulus, aortic valve regurgitation and an ascending aortic aneurysm. Three-dimensional (3-D) reconstruction computed tomographic angiography of the chest showed a 10-cm ascending aortic aneurysm (Figure 1b).
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