ON THE COVER A 25-year-old man presented to the emergency room with chest pain and a 1-month history of progressive shortness of breath and paroxysmal nocturnal dyspnea. He was a basketball player with no medical history and his father suffered sudden death at 29 years of age. Physical examination was notable for a severe aortic regurgitant murmur and minimal basilar rales. Electrocardiography was consistent with left ventricular enlargement. N-terminal pro-B-type natriuretic peptide was 5,120 pg/ml and troponin T was 1.2 ng/ml. Chest X-ray (panel A) showed a widened mediastinum and cardiac enlargement. Ascending aortic aneurysm, including the aortic root, with severe aortic regurgitation and bicuspid valve were demonstrated by echocardiography (panel B). Left ventricle end-diastolic diameter was 78 mm and left ventricular ejection fraction was 40%. Initial thoracic computed tomography (CT) angiography revealed a 95-mm ascending aortic aneurysm with no signs of dissection or intramural hematoma. Further evaluation with an electrocardiographic-gated 64-slice cardiac CT ruled out aortic arch and supra-aortic vessels involvement and assessed for normal coronary arteries (panels C, D, and E). The patient underwent surgery (panel F) having total aortic root and ascending aorta replacement with a valved conduit and re-implantation of the coronary buttons. The patient had a full and satisfactory recovery. Image provided by Alejandro de la Rosa Hernández, PhD, Carlos Rubio-Iglesias García, PhD, Alejandro Sánchez-Grande Flecha, PhD, Alfonso Bonilla Arjona, PhD, Ignacio Laynez Cerdeña, MD, from the Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain. Note: Becas de Ampliación de Estudios en Centros de Excelencia N° Expte: 2/06-03 (FUNCIS), refers to a grant which Dr. de la Rosa received.