Accessory attachment.

摘要

A60-YEAR-OLD MAN with a past medical history significant for obesity, hypertension, hypercholesterol-emia, and a longstanding murmur presented with shortness of breath and fatigue with exertion over a period of 1 week. A transthoracic echocardiogram showed moderate aortic stenosis. A cardiac catheterization was performed and showed severe aortic stenosis (peak gradient of 70 mmHg and valve area of 0.64 cm2), single-vessel coronary artery disease (60%-70% occlusion of mid-left anterior descending artery), and dilation of the ascending aorta (5 cm). Given these findings in a symptomatic patient, the decision was made to proceed to the operating room for a biologic B entail procedure and single-vessel coronary artery bypass graft surgery. After the induction of general anesthesia, a routine pre-cardiopulmonary bypass transesophageal echocardiographic examination was performed, revealing the following image (Fig 1 and Video 1 [supplementary video is available online]). What is the diagnosis?