Figure 4.

Severe aortic valve stenosis and mitral regurgitation in a patient with systemic lupus erythematosus on hemodialysis due to lupus nephritis. The patient was a 59-year-old woman with a 15-year history of SLE. She was introduced to dialysis 10 years earlier due to lupus nephritis. She also had an IVC filter implanted for deep vein thrombosis. (A) 3D-CT shows multiple atheromas around the thoracic aorta and occlusion in the left subclavian artery (white arrow). The ST junction is smaller than the annulus, and the gap is recognized below the commissure. (B and C) TEE showed severe aortic stenosis and mitral regurgitation. The opening of the RCC and NCC of the aortic valve is severely restricted due to severe calcification, and there is mitral regurgitation due to severe calcification of the posterior leaflet of the mitral valve. 3D-CT = three-dimensional computed tomography, AML = anterior mitral leaflet, IVC = inferior vena cava, LA = left atrium, LV = left ventricle, LCC = left coronary cusp, NCC = non-coronary cusp, PML = posterior mitral leaflet, RCC = right coronary cusp, SLE = systemic lupus erythematosus, TEE = transesophageal echocardiography.