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Address correspondence to Paul S. Pagel, MD, PhD, Anesthesia Service, Clement J. Zablocki Veterans Affairs Medical Center, 5000 W. National Avenue, Milwaukee, WI 53295.
A 56-YEAR-old, 68- kg, 165- cm woman with a history of Crohn's disease presented to
the authors’ institution with dyspnea and exercise intolerance of several months’
duration. More recently, her symptoms had progressed to occasional dyspnea at rest.
She denied fever, chills, chest pain or pressure, palpitations, orthopnea, paroxysmal
nocturnal dyspnea, syncope, and peripheral swelling. The physical examination was
notable for a grade III of VI holodiastolic murmur. The electrocardiogram and laboratory
analysis were noncontributory. Transesophageal echocardiography (TEE) was performed
as part of the diagnostic evaluation and the following images were obtained (Fig. 1-4; Videos 1-4). What is the diagnosis?
