# The enigma of fine mobile structures on the aortic surface in a patient undergoing transcatheter aortic valve replacement: a case report

## TL;DR

A case report describes unusual mobile filamentous structures on the aortic surface of a patient who underwent a heart valve replacement, with no harmful effects observed.

## Contribution

The paper presents a novel case of atypical filamentous structures in the aorta, distinct from known pathologies like atheroma or thrombi.

## Key findings

- Filamentous structures were observed in the aorta pre- and post-TAVR, resembling strands attached to the intimal wall.
- These structures were not associated with symptoms or clinical issues during follow-up.
- The structures differ from typical aortic pathologies in appearance and clinical behavior.

## Abstract

The surface of the aorta generally does not show motion unless mobile atheroma, thrombi, vegetations, or intimal flaps are present. We previously described unusual mobile filamentous structures in the carotid artery. Here, we describe similar findings in the aorta and their possible cause.

An 88-year-old female with progressive exertional dyspnoea and severe aortic stenosis had a successful transcatheter aortic valve replacement (TAVR). A filamentous structure was noted on the focused pre-operative 2D transoesophageal echocardiography in the proximal descending aorta and post-TAVR as long strand-like structures attached to the thickened intimal wall with a planar component on 3D imaging. These findings were not associated with symptoms or clinical sequelae on short- and long-term follow-up.

The mobile structures that we describe are atypical for atheroma, thrombi, vegetations, and dissections in terms of their form and clinical presentation. 2D imaging showed that the filaments had focal thickening and emerged from the aortic surface. These findings suggest a relationship with the intima, perhaps from atherogenesis or injury with disruption or lifting of the intimal surface. No clinical sequelae were detected that may also relate to their position in the descending aorta and not the arch.