PMC5288324_01
Echocardiography shows a vegetation (white arrow) attached to the anterior mitral leaflet (a) and severe mitral regurgitation (b).
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Echocardiography showed vegetation near the anterior commissure of the mitral valve as well as a perforation in part of the anterior leaflet, with severe regurgitation (Fig. 1).
MRI image shows subcortical infarction and hemorrhage in the right frontal lobe.
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In addition, brain MRI revealed mycotic cerebral embolism with accompanying hemorrhage, although the patient did not display obvious neurological symptoms (Fig. 2).
Intraoperative view of the mitral valve; a vegetation (black arrow) is located in the anterior mitral commissure.
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During surgery, a 1-cm diameter of spherical vegetation was found attached to the anterior commissure of the mitral leaflet (Fig. 3).
The results of br-PCR. a, Part of the sequence of the PCR products obtained from the vegetation. b, Comparison between the sequence of the PCR products and that registered in the database, showing that they significantly matched the sequence of Aggregatibacter aphrophilus.
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Because cultures of the removed mitral valve and vegetation were negative, we performed br-PCR to identify microorganisms based on partial sequences of divergent regions of the 16S rRNA gene for bacteria, as follows (Fig. 4).