Diagnostic Dilemma| Volume 37, ISSUE 3, P493-495, March 2023

An Additional Structure in the Left Atrium in a Patient Undergoing Aortic Valve Replacement: Artifact or Something Else?

Published:November 25, 2022DOI:
      A 68-year-old, 42- kg, 149- cm woman presented with chief complaints of dyspnea and palpitations of 4 months' duration. Transthoracic echocardiography revealed severe aortic stenosis due to bicuspid aortic valve disease, with peak and mean gradients of 125 and 85 mmHg, respectively. Coronary angiography was normal. She denied a history of syncopal episodes, transient ischemic attack, or cerebrovascular accident. She was afebrile. Normal sinus rhythm was present. Transesophageal echocardiography (TEE) performed before cardiopulmonary bypass confirmed the preoperative diagnosis. A highly mobile structure also was seen in the left atrium in the midesophageal 4-chamber view. The structure was attached to the base of the posterior mitral leaflet (Fig 1, A). Color-flow Doppler did not reveal any turbulence across the mitral valve (Fig 1, B; Video 1). What is the diagnosis?
      Fig 1
      Fig 1(A) Two-dimensional midesophageal 4-chamber view showing the additional structure (arrow) attached at the base of the posterior mitral leaflet. (B) There is no turbulence on color-flow Doppler. LA, left atrium; LV, left ventricle.


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