PMC6000992_01
Transthoracic echocardiogram (TTE) showing tricuspid and mitral vegetations noted on apical fourchamber view. (RA-Right atrium, LA- Left Atrium, RV- Right ventricle, LV- Left ventricle, upward arrow showing mitral vegetation, downward arrow showing tricuspid vegetation).
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It showed a large mobile vegetation on the atrial surface of the tricuspid valve with severe tricuspid regurgitation. (Fig. 1) Severe global hypokinesis with systolic ejection fraction of 25% was also noted. An echogenic non-mobile structure was noted on the posterior mitral leaflet with moderate mitral regurgitation (Fig. 1).
Transesophageal echocardiogram (TEE) showing large tricuspid vegetation on Midesophageal four-chamber view. (Downward arrow showing tricuspid vegetation).
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A 0.5 x 0.6 cm sessile echodensity was noted attached to posterior mitral valve that appeared calcified and consistent with old vegetation on the TEE. (Fig. 2, Fig. 3).