Fig. 1

Echocardiogram. A Transthoracic echocardiogram, before surgery, two-dimensional, Doppler and color Doppler interrogation, parasternal long axis: Bicuspid and thickened aortic valve with vegetation (arrow), moderate to severe aortic valve regurgitation and mild to moderate aortic stenosis, mildly dilated left atrium and left ventricle with mild to moderate hypertrophy. B Transesophageal echocardiogram, after surgery, two-dimensional, Doppler and color Doppler interrogation: There is no left ventricular outflow tract obstruction. On-X mechanical valve shows no vegetation (arrow), with no significant stenosis or regurgitation. Left ventricle is mildly dilated with mild to moderately diminished systolic function