TY - JOUR T1 - An unusual structure on transthoracic echocardiography JF - Heart JO - Heart SP - 344 LP - 406 DO - 10.1136/heartjnl-2021-320576 VL - 108 IS - 5 AU - Abhishek Thakur AU - Anish Kapil AU - Nirmal Ghati Y1 - 2022/03/01 UR - http://heart.bmj.com/content/108/5/344.abstract N2 - A man in his 50s presented to the emergency department with recurrent syncope. His medical history was notable for diabetes mellitus and hypertension. ECG showed a complete heart block with a ventricular escape rate of 30 beats per minute. Transvenous temporary pacemaker was inserted. Transthoracic echocardiography (TTE) showed severe left ventricular dilation and systolic dysfunction, ejection fraction of 30%. A modified apical four-chamber view showed an unexpected structure (figure 1, online supplemental video).Supplementary video [heartjnl-2021-320576supp001.mp4] Figure 1 Transthoracic echocardiogram in the apical four-chamber view with a slight anterior angulation. Unexpected finding denoted by the white arrow.What is the structure shown in figure 1?Echogenic artefactCalcified coronary arteryRetroaortic anomalous coronary arteryAortic valve calcificationC. Retroaortic anomalous coronary artery … ER -