PMC10033739_01
Top panel: 2D (A) and 3D (B) trans-oesophageal echocardiography showing large vegetations (white arrows) on the anterior mitral leaflet in the three chamber mid-oesophageal view. Middle panel: 2D trans-oesophageal echocardiography at mid-oesophageal level showing perforations in A2 and A3 scallop of the anterior mitral valve leaflet (C, white arrow) complicated by severe mitral regurgitation (D). Bottom panel: 3D trans-oesophageal echocardiography at mid-oesophageal level showing anterior mitral valve leaflet perforation (E, white arrow). Two-dimensional transthoracic echocardiogram parasternal short axis view (F) showing A2 and A3 leaflet perforation (white arrows) with colour flow jets through the perforations.
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Trans-thoracic and trans-oesophageal echocardiography revealed severe mitral and tricuspid valve regurgitation complicated by pulmonary hypertension (Fig. 1). Mitral valve perforations and vegetations were visible confirming the diagnosis of infective endocarditis (Fig. 1) and the indication for urgent valvular surgery.
Computed tomography angiogram showing acute arterial occlusion of the left radial artery (white arrow) due to embolism.
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An urgent computed tomography angiogram revealed occlusion of the left radial artery and an open arterotomy and thrombectomy was performed, restoring perfusion to his hand with a good clinical outcome and no consequent tissue or functional loss (Fig. 2).
Resected anterior mitral valve specimen showing a large vegetation on the anterior mitral valve leaflet (red arrows).
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A mitral valve replacement was performed using a Hancock II bioprosthetic mitral valve (Fig. 3) and the patient was transferred back to our hospital one week post-operatively.