Three-dimensional transesophageal echocardiographic recognition of mobile mass protruding into the left main coronary orifice in a patient with aortic stenosis.

摘要

An 81-year-old man was referred for 3D transesopha-geal echocardiography (3DTEE) for evaluation of aortic stenosis possibly because of a bicuspid aortic valve. On the 2D short-axis view of the aortic valve, a mobile calcific mass was incidentally found near the orifice of the left main coronary artery. Cropped live 3D mode (X7-2t, Philips Medical Systems, Andover, MA, USA) of the aortic valve provided more detailed and comprehensive information regarding the temporal relationship between this mobile mass and the left main coronary orifice. The mass was attached to the left side of the anterior leaflet of the bicuspid aortic valve, and moved back and forth, intermittently protruding into the left main coronary orifice (Figure 1, Movies 1,2). Coronary. angiography was cancelled, and alternative cardiac multide-tector computed tomography (MDCT) revealed no coronary artery stenosis. Direct inspection of the aortic valve during cardiac surgery verified the partial detachment of the calcific nodule on the valve leaflets, confirming the accuracy of the preoperative 3D images (Figure 2). The patient underwent successful aortic valve replacement without any perioperative complications.