Case presentation
A 60 years old woman with history of dyspnea on exertion from 2 years
ago presented to the Tehran Heart Center[3]. After initial
evaluations in trans-thoracic echocardiography (TTE) severe mitral
stenosis with score Wilkins[4] score 7 was diagnosed. She was
planned to undergo TEE for further evaluation and probable PTMC in this
admission. She was on Inderal 20 daily from 6 months ago and furosemide
20 daily was added recently due to her dyspnea. TEE was done without
complication after local anesthesia with 1.5 mg midazolam. Severe MS was
seen and low LAA velocity (28.2 cm/s) was noted, Figure 1; Panel A.
Suspicious mass was seen near LAA and was first consumed to be a LAA
thrombosis. After more angulations of the probe and other off-axis views
it was considered as a well- defined mass-like lesion in TS, Figure 1;
Panel B; measuring 2.35 cm*2.65 cm, Figure 1; Panel C. In this figure,
one can also notice thick epicardial fat pad. The Echogenisity of lesion
within TS is exactly like the epicardial fat around right ventricle
(RV), Figure 1, Panel C thin arrow.
Three-dimension mapping was performed with live 3D wide angled full
volume TEE. Echogenicity and features of the lesion was against
thrombosis and was in favor of fat tissue, Figure 1; Panel D. Hence,
TSFP was diagnoses. Videos of 3D and 2D TEE imaging has been attached as
a supplementary file.