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A. A 26-mm SAPIEN XT deployed via a transapical approach; B, C. Macroscopic findings showing the anterior mitral leaflet (AML) was injured by mechanical stimulation from the bottom of implanted valve (arrow); D. Microscopic findings showing elastic fiber injured by mechanical stimulation (arrow); XT : SAPIEN XT valve.
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Irvine, CA, USA). It was deployed via transapical approach under general anesthesia (Fig. 1A). Macroscopically the anterior mitral leaflet (AML) was injured with a small ulceration without vegetations (Fig. 1B, C). Microscopic findings in Elastica Masson stain surprisingly revealed focal ulceration in the ventricular side of the AML, possibly caused by mechanical stimulation rather than infectious endocarditis (Fig. 1D).