We describe an adult patient with a large right atrial mass which was found to have the same echotexture as adjacent liver tissue on two-dimensional transesophageal echocardiography (2DTEE). By using live/real-time three-dimensional transesophageal echocardiography (3DTEE), we were able to examine the mass by meticulous cropping and confirm the echotexture was similar to liver tissue throughout its extent. Three-dimensional cropping also redemonstrated in a definitive manner that the mass was in continuity with liver. Thus, in our patient 3DTEE served to increase the confidence level of making a definitive diagnosis of a supernumerary lobe of liver. To the best of our knowledge, the incremental value of 3DTEE over 2DTEE in diagnosing a supernumerary liver lobe has not been reported previously. The mass was surgically resected and the findings confirmed as liver tissue by pathological examination.

Mitral valve replacement in the setting of mitral annular calcification (MAC) remains a surgical challenge fraught with several known complications. We present an innovative and hybrid approach involving robotic-assisted deployment of a SAPIEN S3 (Edwards Lifesciences, Irvine, CA) in the mitral position of a patient with severe MAC in the setting of previous sternotomy for aortic valve replacement. The robotic platform allowed avoidance of redo sternotomy, paravalvular leaks adjustment through excellent visualization from the right chest, and better assessment of the risk of left ventricular outflow tract obstruction. This report serves as an alternative technique for the management of mitral valve surgery associated with MAC in the era of transcatheter and minimally-invasive cardiac operations.