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Address correspondence to Satyajeet Misra, MD, DNB, PDCC, TOE (EACVI), Department of Anesthesiology and Critical Care, All India Institue of Medical Sciences Bhubaneswar, Bhubaneswar 751019, Odisha, India
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(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.
