Real-Time 3-Dimensional Transesophageal Echocardiography in the Evaluation of a Patient With Concomitant Double-Orifice Mitral Valve, Bicuspid Aortic Valve, and Coarctation of the Aorta

A 35-year-old woman was referred for further cardiovascular 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) transthoracic echocardiogram (TTE) demonstrated normal left ventricular (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 …