Tauqir Y. Goraya, MD, PHD, Farouk Mookadam, MD, Andre C

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Calcified Bicuspid Aortic Valve Mass Prolapsing Into the Left Main Coronary Artery Tauqir Y. Goraya, MD, PHD, Farouk Mookadam, MD, Andre C. Lapeyre, MD, Richard C. Daly, MD, Henry D. Tazelaar, MD, Kyle W. Klarich, MD Mayo Clinic Proceedings Volume 75, Issue 10, Pages 1081-1085 (October 2000) DOI: 10.4065/75.10.1081 Copyright © 2000 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 1 Preoperative transesophageal echocardiogram. In the longitudinal (A) and transverse (B) views, a pedunculated mass(arrow) is seen arising from the aortic valve(AV). Asc Ao=ascending aorta;LVOT=left ventricular outflow tract. Mayo Clinic Proceedings 2000 75, 1081-1085DOI: (10.4065/75.10.1081) Copyright © 2000 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 2 Coronary angiogram showing filling defect in left main coronary artery (arrow). LAD= left anterior descending coronary artery; LCX=left circumflex coronary artery; LM =left main coronary artery. Mayo Clinic Proceedings 2000 75, 1081-1085DOI: (10.4065/75.10.1081) Copyright © 2000 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 3 Intraoperative transesophageal echocardiogram. In both longitudinal views (A and B), a pedunculated mass (arrow) is seen arising from aortic valve (AV), with distal end prolapsed into left main coronary artery. Asc Ao = ascending aorta; LM = ostium of left main coronary artery; LVOT = left ventricular outflow tract. Mayo Clinic Proceedings 2000 75, 1081-1085DOI: (10.4065/75.10.1081) Copyright © 2000 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 4 Intraoperative findings. Calcified bicuspid aortic valve (AV) as viewed from aortic side. Pedunculated mass (arrow) is seen arising from conjoined raphe of left and noncoronary cusps. LM= left main coronary artery. Mayo Clinic Proceedings 2000 75, 1081-1085DOI: (10.4065/75.10.1081) Copyright © 2000 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 5 Section of aortic valve mass showing the presence of calcium fragments (arrow), fibrin, and bland thrombus (hematoxylin-eosin, original magnification x100). Mayo Clinic Proceedings 2000 75, 1081-1085DOI: (10.4065/75.10.1081) Copyright © 2000 Mayo Foundation for Medical Education and Research Terms and Conditions