Unusual lesion around aortic root: identification using real-time three-dimensional transesophageal echocardiography.

摘要

Mitral valve replacement was performed in a 61-year-old female patient, who was diagnosed to have rheumatic mitral stenosis, mitral regur-gitation, and atrial fibrillation (AF). Preoperative transthoracic echocardiography (TTE) revealed a normal left ventricular systolic function, and a giant left atrium (GLA), which was 84 mm in width. After anesthesia induction, heart was inspected using three-dimensional (3D) transesophageal echocardiography (I/E 33, Philips Medical Systems, Bothell, WA, USA) which confirmed the TTE findings. After the establishment of cardiopul-monary bypass (CPB) and administration of car-dioplegia infusion, the mitral valve was excised and replaced with a size 31 tilting disc prosthetic valve. The enlarged left atrium (LA) was plicated at its appendage, roof, and also around the an-nulus of mitral valve. Patient was weaned from CPB with infusion of dobutamine 10 mcg/kg per minute in a stable hemodynamic condition. After achieving surgical hemostasis, the chest was closed. Inspection of aortic valve (AV) in long-axis view showed a lesion near the aortic root, which was multilobed and cystic in appearance. Color flow Doppler examination revealed absence of flow in the structure. There was no evidence of aortic dissection and AV incompetence.