Intermittent left coronary occlusion caused by native aortic valve thrombosis in a patient with protein S deficiency

A 77-year-old woman presented with chest pain and cardiogenic shock Transes ophageal echocardiography showed a mobile mass occluding intermittently the left coronary ostium, The mass was surgically resected, and histologic exa mination revealed an organized thrombus. Coagulation study demonstrated a p rotein S deficiency. This is the first case of aortic thrombosis associated with protein S deficiency and it is the first time that transesophageal ec hocardiography provided definite evidence that a mass can cause intermitten t left ostium coronary obstruction.