Real-time 3-dimensional transesophageal echocardiography is valuable for the detailed anatomical evaluation of complex concomitant congenital heart lesions.
A 35-year-old woman was referred for further cardiovas-cular assessment after an incidental finding of a systolic murmur and symptoms of exertional chest tightness. On examination, she had an anacrotic pulse with an aortic ejection systolic murmur. Two-dimensional (2D) transthorac-ic echocardiogram (TTE) demonstrated normal left ventricu-lar (LV) size and systolic function with a thickened and calcified bicuspid aortic valve. The mean gradient was 47 mm Hg, and valve area was 0.8 cm2, consistent with severe aortic stenosis. There was mild coarctation of the aorta with a peak velocity of 2.5 m/s. The mitral valve appeared structurally abnormal (Figures 1 and 2 and online-only Data Supplement Movies I and II). However, 2D TTE images were suboptimal. Therefore, 2D transesophageal echocardiography (TEE) was performed. This confirmed a bicuspid aortic valve with severe aortic stenosis and mild aortic regurgitation with
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Aggarwal et al. (2009) studied this question.
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