Iatrogenic aortic valve injury after cardiac operations performed with the transaortic approach have been occasionally reported. Among them, suture-related injury to an aortic valve can produce leaflet perforation with aortic regurgitation after cardiac operations performed in the vicinity of the aortic valve is rare, but is probably under-reported. So an increment in the awareness of this entity and careful transthoracic and transesophageal echocardiographic examinations are necessary to evaluate iatrogenic aortic valve perforation in patient with new murmur of aortic regurgitation after cardiac operations in the proximity to the aortic valve. We experienced a case of iatrogenic aortic valve leaflet perforation after closure of ventricular septal defect (VSD). A 22-year-old woman presented with atypical chest pain of 2 years' duration. The left chest pain was prickling of 10 to 20 minutes duration regardless of exercise. She had past history of repair of uncertain type of a VSD in army hospital 15 years ago. Physical examination revealed a blood pressure of 130/70 mmHg and other stable vital signs. There was grade 1 early diastolic murmur over Erb���s area. Chest X-ray showed normal cardiac silhouette and normal pattern of pulmonary vascularity. ECG revealed complete right bundle branch block. Transthoracic echocardiography was performed. 2-D echocardiographic study showed normal dimension of cardiac chambers, global systolic function of LV (ejection fraction was 71%), and slit-like defect at junction of infundibular portion of ventricular septum and aortic annulus. Continuous wave and color flow Doppler studies revealed jet flow originated from the defect immediately beneath the aortic valve into left ventricle in early diastole. Transesophageal echocardiography was performed to ascertain diagnosis, it revealed small perforation in the edge of right coronary cusp of the aortic valve and mild to moderate aortic regurgitant flow with quite high velocity (6m/sec). She has been following up outpatient department without complication.