A Rare Case of Severe Aortic Regurgitation Secondary to Tenting of Chordae Tendineae Strands: A Multimodality Imaging Approach for a Challenging Diagnosis

We discuss a case of a patient who was referred to our department for an in-depth evaluation of aortic regurgitation severity and its underlying causes. By employing a multimodal imaging strategy that combined transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and cardiac magnetic resonance imaging (cMRI), we successfully identified a particularly rare cause of aortic regurgitation: chordae tendineae that lead to asymmetric retraction of the aortic cusps. Furthermore, this approach provided a clearer understanding of the aortic root anatomy and the hemodynamic effects of the regurgitant flow on the ventricle. This case demonstrates the diagnostic effectiveness of various imaging techniques and emphasizes the crucial importance of multimodal imaging for a thorough assessment of aortic valvular issues.