A 70-year-old man presented with dyspnea, which he had been experiencing for 2 months. Grade 3 diastolic murmur was heard at the right upper sternal border. Eight months earlier, he had undergone transradial coronary angiogram at another hospital. The right coronary artery was difficult to cannulate with an Amplatz 2 catheter because of anomalous origin of the right coronary artery (A). On echocardiography, perforation of the noncoronary cusp (NCC) with a linear mobile structure was suspected as a cause of severe aortic regurgitation (B [arrow] and C;Online Videos 1, 2, and 3), which was not seen on the previous examination. He underwent aortic valve replacement, and the excised aortic valve revealed a tear in the NCC (D).

A 72-year-old woman was referred from another hospital because of acute pulmonary edema 1 week after transradial coronary angiography. The engagement of the right coronary artery was extremely difficult (E). Echocardiography showed severe aortic regurgitation with a linear structure, suggesting aortic valve avulsion (F [arrow] and G; Online Videos 4, 5, and 6). A surgical specimen of the aortic valve revealed laceration of the NCC (H). LCC = left coronary cusp; RCC = right coronary cusp.