“…In the 3 years of follow up, the patient is stable without significant change of echocardiographic parameters. A similar case was reported in which an elderly male with four equal sized cusps with moderate AR, as in our study, was managed under medical therapy [17]. Another case was stated by D'Aloia et al [9], in which presence of a smaller hypoplasic cusp lead to abnormal leaflet coaptation and mild aortic root dilatation, resulting into worsening of AR.…”