{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T18:28:41Z","timestamp":1760984921811},"reference-count":3,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2013,11,13]],"date-time":"2013-11-13T00:00:00Z","timestamp":1384300800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Echocardiography"],"published-print":{"date-parts":[[2014,2]]},"abstract":"<jats:p>There is a long\u2010standing debate between proponents of routine intra\u2010operative echo and those who want it restricted to selected groups of patients (such as those undergoing valve repair or correction of congenital abnormalities). We present a case where routine transesophageal echocardiography (<jats:styled-content style=\"fixed-case\">TEE<\/jats:styled-content>) identified completely unexpected pathology, with implications for the postoperative follow\u2010up and for patient outcomes. A 64\u2010year\u2010old male, with a history of surgical repair of coarctation of the aorta in childhood, was admitted for elective valve replacement for severe aortic stenosis (<jats:styled-content style=\"fixed-case\">AS<\/jats:styled-content>). Previous transthoracic echocardiography had not identified any other pathology apart from <jats:styled-content style=\"fixed-case\">AS<\/jats:styled-content>, but routine intra\u2010operative <jats:styled-content style=\"fixed-case\">TEE<\/jats:styled-content> picked up severe turbulence in the left ventricular outflow tract (<jats:styled-content style=\"fixed-case\">LVOT<\/jats:styled-content>). On further analysis this was due to 2 mechanisms: a localized subaortic membrane and a \u201ccystic\u201d mass attached to the anterior mitral leaflet, protruding into the <jats:styled-content style=\"fixed-case\">LVOT<\/jats:styled-content> in systole. Multiplane imaging of the mass disclosed an accessory mitral valve (MV), a rare congenital abnormality. The patient had excision of the stenosed aortic valve and of the subaortic membrane, while the accessory MV was spared, as the surgeon judged its removal might distort the mitral apparatus. Postoperative recovery was unremarkable and the patient went home with symptomatic improvement. This case illustrates the fact that even \u201cstandard\u201d cardiac procedures can benefit from intra\u2010operative <jats:styled-content style=\"fixed-case\">TEE<\/jats:styled-content> which, in our view, should be available for all patients who undergo heart surgery.<\/jats:p>","DOI":"10.1111\/echo.12436","type":"journal-article","created":{"date-parts":[[2013,11,13]],"date-time":"2013-11-13T12:05:11Z","timestamp":1384344311000},"source":"Crossref","is-referenced-by-count":3,"title":["Accessory Mitral Valve\u2014An Unexpected Intra\u2013Operative <scp>TEE<\/scp> Finding Causing Left Ventricular Outflow Tract Obstruction in an Adult"],"prefix":"10.1111","volume":"31","author":[{"given":"Maria Magdalena","family":"Gurzun","sequence":"first","affiliation":[{"name":"Morriston Regional Cardiac Centre Morriston Wales United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Farhan","family":"Husain","sequence":"additional","affiliation":[{"name":"Morriston Regional Cardiac Centre Morriston Wales United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Afzal","family":"Zaidi","sequence":"additional","affiliation":[{"name":"Morriston Regional Cardiac Centre Morriston Wales United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrian","family":"Ionescu","sequence":"additional","affiliation":[{"name":"Morriston Regional Cardiac Centre Morriston Wales United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2013,11,13]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.105.592089"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2005.01.027"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2012-006949"}],"container-title":["Echocardiography"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fecho.12436","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/echo.12436","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,2]],"date-time":"2023-10-02T13:01:01Z","timestamp":1696251661000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/echo.12436"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,11,13]]},"references-count":3,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2014,2]]}},"alternative-id":["10.1111\/echo.12436"],"URL":"https:\/\/doi.org\/10.1111\/echo.12436","archive":["Portico"],"relation":{},"ISSN":["0742-2822","1540-8175"],"issn-type":[{"value":"0742-2822","type":"print"},{"value":"1540-8175","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,11,13]]}}}