Prosthetic heart valve.

A 55-year-old invasive/clinical cardiologist worked full time, exercised regularly, and was asymptomatic. Two weeks previously, he had new onset of angina on exertion. Echocardiography/Doppler and cardiac catheterization confirmed the clinical assessment of severe aortic stenosis with a valve area of 0.5 cm/m. The aortic valve was tricuspid; left ventricular ejection fraction was 0.60. Coronary arteriography showed no obstructive coronary artery disease. His bodymass index was 23 kg/m, body surface area 1.7 m, blood pressure 110/ 70 mm Hg, low-density lipoprotein 70 mg/dL, creatinine clearance 120 mL/ min, and hemoglobin A1c 5.0. He had no comorbid conditions, and had never smoked.