Midesophageal short-axis view of aortic valve. A large vegetation (black dotted line) is attached to the left coronary cusp and occluding the left main coronary ostium. LA: left atrium, LCA: left coronary artery, RA: right atrium, RVOT: right ventricular outflow tract, L: left coronary cusp, R: right coronary cusp, N: non-coronary cusp.