PMC7086418_01
(a) Cherry red spot at the center of the fundoscopy. (b) Echolucent area in the mitral-aortic fibrosa with a hyperechogenic structure inside (red circle). (c) Reconstruction through transoesophageal echocardiography showing the mitral-aortic intervalvular fibrosa with a pseudoaneurysm (arrow) communicating with the left ventricle outflow tract and a free thrombus inside. (d) Transoesophageal echocardiography at 126  showing a free hyperechogenic highly mobile structure inside a pseudoaneurysm in the mitral-aortic intervalvular fibrosa, protruding into the LVOT through a small orifice. LA: left atrium; LV: left ventricle; Ao: ascending aorta.
CRIC2020-3192957.001.jpg
PMC7086418_01_CRIC2020-3192957.001.jpg
fig1
A fundoscopic exam was immediately performed and identified the foveola assuming a cherry red spot-like image with retinal whitening, which suggested that the visual loss had been caused by a central retinal artery occlusion (Figure 1(a)). TTE was performed, showing a nonobstructive aortic prosthesis and a periprosthetic echolucent pulsatile region with a hyperechogenic mobile round structure inside (Figures 1(b) and 2). To better characterize these findings, a TOE was performed (Figures 1(c), 1(d), 3, and 4) revealing a free hyperechogenic highly mobile structure suggestive of a free thrombus inside a pseudoaneurysm in the mitral-aortic intervalvular fibrosa, protruding into the left ventricular outflow tract through a small communication orifice (supplementary material  and ).