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Pseudoaneurysm of the mitral-aortic intervalvular fibrosa is a rare complication of infective endocarditis of the aortic valve eventually resulting in coronary artery compression, stroke or rupture into the left atrium, aorta or pericardial space. A prompt diagnosis by either transthoracic or transesophageal echocardiography is mandatory to address the patient to cardiac surgery. We report the clinical case of a 25-year-old white man who was admitted to the emergency department for dyspnoea and fever. Echocardiographic examination showed a bicuspid aortic valve with a huge sessile vegetation and a pseudaneurysm of the mitral-aortic intervalvular fibrosa. In addition to conventional two-dimensional examination, three-dimensional echocardiography provided additional information of this complication, precisely delineating the lesions and addressing the cardiac surgeon in choosing the most appropriate operating strategy. Patient underwent then aortic root replacement and the pseudoaneurysm was closed by means of a bovine pericardial patch. (Echocardiography 2011;28:E1-E4)We report the clinical case of a 25-year-old white man with bicuspid aortic valve endocarditis complicated by a pseudoaneurysm of the mitral-aortic intervalvular fi brosa. Although two-dimensional echocardiography was helpful in identifying this complication, three-dimensional imaging provided a better defi nition of the pathology, precisely delineating the lesions and addressing the cardiac surgeon in choosing the most appropriate operating strategy.