A1

The correct answer is E, left ventricular assist device. The M-mode through the aortic valve reveals that the aortic valve remains closed throughout the cardiac cycle, i.e. there is no ejection though the aorta. This can only take place in the presence of cardiopulmonary bypass or a left ventricular assist device, which totally unload the left ventricle. A bicuspid aortic valve would show opening of the aortic valve with an asymmetric coaptation point. Aortic stenosis would cause thickened and calcified aortic valve leaflets with decreased excursion. Aortic regurgitation is difficult to diagnose on M-mode of the aortic valve but one can see a causal vegetation and possibly prolapse of one of the leaflets. A mechanical valve has stereotypic appearance with echo-reflective leaflets and abrupt opening/closing.