Abstract
A 75-YEAR-OLD woman was referred for evaluation 10 days after acute anterior wall myocardial infarction. Cardiac catheterization showed depressed left ventricular ejection fraction (25%) and anteroseptal akinesia. No other abnormalities were seen. Coronary angiography revealed occlusion of the left anterior descending (LAD) coronary artery with small-caliber circumflex and right coronary arteries. Urgent off-pump coronary artery bypass graft surgery to the LAD was scheduled for the next day. After induction of general anesthesia, transesophageal echocardiography (TEE) was performed. A transgastric midpapillary view of the left ventricle showed a moderate size (3 cm × 3 cm) echo-dense mass together with areas of calcification (Fig 1). Differential diagnosis included an intraventricular thrombus, a prominent papillary muscle, or an anomalous band. Moderate dyskinesia of the left ventricular apex was also noted. Left ventricular ejection fraction was estimated to be around 25%. What is the diagnosis?
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