The echo-Doppler diagnosis of aortic valve perforation has seldom been made before. We describe a combination of findings in a patient with severe aortic regurgitation following endocarditis of a bicuspid aortic valve, which suggests the presence of aortic cusp perforation: (A) discontinuity of cusp contour i n parasternal long-axis view; (B) emergence of aortic regurgitant jet through a cusp rather than between the two cusps; (C) fine flutter of a cusp, but not on the free apposed edges; (D) severe aortic regurgitation without flail cusp motion, following bacterial endocarditis. (ECHOCARDIUGRAPHY, Volume 12, May 1995) aortic valve, endocarditis, aortic valve, perforation, aortic valve, bicuspid 378 ECHOCARDIOGWHY: