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Diagnosis of an aortic valvular lesion
  1. Omeed Elboudwarej,
  2. Janet Wei,
  3. Robert Siegel
  1. Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
  1. Correspondence to Robert J Siegel, Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA; Robert.Siegel{at}cshs.org

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Clinical introduction

A 59-year-old woman with hypertension presented with right-sided weakness and vision loss. Her vital signs were normal; cardiopulmonary exam was significant for a systolic and diastolic murmur. MRI of the brain showed multiple chronic bilateral infarctions, and Doppler ultrasound revealed acute left lower extremity deep vein thrombosis. Transthoracic echocardiography (TTE) to determine cardioembolic source of stroke was significant only for severe aortic valve regurgitation. To assess for cardiac vegetations, transoesophageal echocardiography (TEE) was performed (figure 1). Thrombophilic workup revealed positive antinuclear antibody (titre 1:640) and lupus anticoagulant; the remaining lupus serologies were negative. …

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