An unusual cardiac mass shown by intraoperative transesophageal echocardiography

Abstract

A 49-YEAR-OLD man with a history of coronary artery disease (CAD) and three prior myocardial infarctions (MIs) was admitted to an outside hospital with the recent onset of unstable angina. A coronary anglogram demonstrated an 80% mid-left anterior descending artery (LAD) occlusion, an 80% first diagonal occlusion, a subtotal circumflex occlusion, and moderate right coronary artery (RCA) disease. The left ventriculogram showed regional left ventrlcular dysfunction, and the electrocardiogram demonstrated an old inferior wall MI and new lateral wall ischemia. After an acute MI was ruled out, the patient was treated with intravenous heparin and nitroglycerin and transferred to this institution for surgical revascularization. Anesthetic induction was uneventful and baseline hemodynamic parameters were within normal limits. Routine biplane transesophageal echocardiography (TEE) exammation after induction showed an unusual structure m the four-chamber long-axis view (Fig 1). Color Doppler imaging showed minimal to no flow within this structure. What is this lesion?