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  Indian J Med Microbiol
 

Figure 1:(a) Clinical photograph showing tendon xanthoma over the dorsum part of the elbows and lateral parts of the foot. (b) The initial ECG showed left ventricular hypertrophy with strain pattern. (c) The ECG on arrival to emergency room showed a new-onset left bundle branch block suggestive of acute coronary syndrome before undergoing definitive cardiothoracic surgery. (d) Echocardiography revealed dense calcifications of the root of aorta and proximal part of the ascending aorta with sparing of the aortic valve (white arrowhead). (e) Also, four-chamber view with color flow mapping showed severe mitral regurgitation. (f) M-mode echocardiography of left ventricle showed severe left ventricular dysfunction, global hypokinesia, with ejection fraction of 32%. (g) The continuous wave Doppler recorded severe gradient across the aortic valve. (h and i) The CT angiography demonstrated the dense deposits of calcium in the aortic annulus and ascending aorta (solid white arrow and dashed white rectangle). (k) Volume-rendered angiography of coronary arteries showed nonobstructive plaques of the proximal segment of the left anterior descending artery (white dashed circle). (j) Patchy distribution throughout the aorta extending to the iliac artery. (n and o) Aortic root angiography elucidated the tubular narrowing of the ascending aorta above the aortic valve (sinotubular junction) with sparing of the aortic valve , Panel n; white arrow head, RAO caudal view, Panel o. (dashed line, LAO view, Panel n; white arrow head, RAO caudal view, Panel o). (l) Selective angiography of the right brachiocephalic artery showed the complete occlusion of the right common carotid artery (white dashed arrows). (m) The left carotid artery showed severe stenosis of internal carotid artery (white dashed arrow). ECG: Electrocardiogram, CT: Computed tomography, LAO: Left anterior oblique, RAO: Right anterior oblique

Figure 1:(a) Clinical photograph showing tendon xanthoma over the dorsum part of the elbows and lateral parts of the foot. (b) The initial ECG showed left ventricular hypertrophy with strain pattern. (c) The ECG on arrival to emergency room showed a new-onset left bundle branch block suggestive of acute coronary syndrome before undergoing definitive cardiothoracic surgery. (d) Echocardiography revealed dense calcifications of the root of aorta and proximal part of the ascending aorta with sparing of the aortic valve (white arrowhead). (e) Also, four-chamber view with color flow mapping showed severe mitral regurgitation. (f) M-mode echocardiography of left ventricle showed severe left ventricular dysfunction, global hypokinesia, with ejection fraction of 32%. (g) The continuous wave Doppler recorded severe gradient across the aortic valve. (h and i) The CT angiography demonstrated the dense deposits of calcium in the aortic annulus and ascending aorta (solid white arrow and dashed white rectangle). (k) Volume-rendered angiography of coronary arteries showed nonobstructive plaques of the proximal segment of the left anterior descending artery (white dashed circle). (j) Patchy distribution throughout the aorta extending to the iliac artery. (n and o) Aortic root angiography elucidated the tubular narrowing of the ascending aorta above the aortic valve (sinotubular junction) with sparing of the aortic valve , Panel n; white arrow head, RAO caudal view, Panel o. (dashed line, LAO view, Panel n; white arrow head, RAO caudal view, Panel o). (l) Selective angiography of the right brachiocephalic artery showed the complete occlusion of the right common carotid artery (white dashed arrows). (m) The left carotid artery showed severe stenosis of internal carotid artery (white dashed arrow). ECG: Electrocardiogram, CT: Computed tomography, LAO: Left anterior oblique, RAO: Right anterior oblique