The patient is a 43-year-old woman with a history of Marfan syndrome. She had a Bentall procedure 10 years ago with a composite Dacron graft (INVISTA, North Wichita, Kansas) replacing the native ascending aorta and a mechanical St. Jude Medical aortic valve (St. Jude Medical, St. Paul, Minnesota). The patient now presents complaining of sharp chest pains worse not only with inspiration but also with firm palpation. An echocardiogram was done to further evaluate the patient’s chest pain (Videos 25-1 to 25-3 and Figs. 25-1, 25-2 and 25-3).