Education  |   February 2018
“Golf Ball” in the Left Ventricular Outflow Tract?
Author Notes
  • From the Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia.
  • Charles D. Collard, M.D., served as Handling Editor for this article.
    Charles D. Collard, M.D., served as Handling Editor for this article.×
  • Address correspondence to Dr. Bora: vbora@augusta.edu
Article Information
Education / Images in Anesthesiology / Cardiovascular Anesthesia
Education   |   February 2018
“Golf Ball” in the Left Ventricular Outflow Tract?
Anesthesiology 2 2018, Vol.128, 388. doi:10.1097/ALN.0000000000001881
Anesthesiology 2 2018, Vol.128, 388. doi:10.1097/ALN.0000000000001881
A 13 × 20 mm mobile vegetation (image A) resembling a golf ball, and causing dynamic left ventricular outflow tract (LVOT) obstruction, was found to be attached to the anterior mitral valve leaflet (AMVL) on the ventricular side by transesophageal echocardiography in the midesophageal long-axis view, sparing the posterior mitral valve leaflet (PMVL). Most vegetations on the mitral valve attach to the atrial (low flow, left atrium [LA]) side of the leaflet, but on rare occasions are on the ventricular (high flow) side.1  Vegetation location, regurgitation mechanism, and severity of the LVOT obstruction were assessed by color flow Doppler. The presence of the mass on the leaflet tip prevented leaflet coaptation, resulting in central mitral regurgitation (MR) in systole.2  There was flow convergence within the left ventricle (LV) proximal to the mass as well as flow acceleration that began at the mass proximal to the aortic valve, causing a dynamic LVOT obstruction (image B). This large (greater than 10 mm) mass posed a high risk for systemic embolization.3 
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