A hypertensive, non-diabetic woman in her 80s with a previous history of aortic valve replacement six months prior was concerned about her class III exertional angina despite optimal medical management. Her pre aortic valve surgery angiogram was normal. General examination was unremarkable except for a short ejection systolic murmur. Electrocardiography showed changes in concentric left ventricular hypertrophy. Twodimensional echocardiography showed normal left ventricular systolic function with a fairly well functioning aortic bio prosthesis. Color Doppler study showed a mosaic turbulent flow pattern in the proximal right coronary artery (RCA) on parasternal long axis view (Figure 1A, Movie 1). Pulse wave Doppler showed increased flow velocities in the proximal RCA which was suggestive of stenosis (Figure 1B). Systolic and diastolic velocities in the proximal RCA were 1.0 and 0.8 m/s respectively.
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