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Valvular pathology diagnosed with transesophageal echocardiography during aortic root replacement

      A 22-year-old man was admitted with a known history of congenital aortic insufficiency (AI) after a 6-month history of worsening dyspnea on exertion, fatigue, and paroxysmal atrial fibrillation. His past medical history was significant for cocaine, marijuana, heroin, and tobacco abuse. He denied fevers, chills, rigors, or night sweats. A complete blood count revealed no abnormal leukocytosis. Medications included amlodipine, aspirin, and amiodarone. Echocardiogram revealed severe left ventricular (LV) dilatation (LV diastolic diameter 79 mm), severe AI, and a LV ejection fraction of 70% to 75%. Cardiac catheterization confirmed severe AI, LV ejection fraction of 55%, LV end-diastolic pressure of 30 mmHg, with right ventricular and pulmonary arterial pressures of 26/8 and 26/16, respectively.

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