PMC9833957_01
Transesophageal echocardiography in mid-esophageal view (0 degree) showed large vegetation attached to the atrial side of anterior mitral valve leaflet (A), and Transesophageal two-dimensional echocardiography and color Doppler flow velocity mapping in the mid-esophageal long-axis view (78 degree) revealed severe MR due to infective destruction of the anterior mitral leaflet (B). LA, left atrium; LV, left ventricle; MR, mitral regurgitation
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These findings were highly suggestive of mitral valve infective endocarditis (Figure 1).
Explanted mitral valve vegetation
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The explanted valve and vegetation (Figure 2) were sent to the reference Mycology Laboratory.
(A) Dichotomous branching hyphae in KOH preparation (40x magnification). (B) Bluish-green Aspergillus colonies on Sabouraud dextrose agar. (C) The microscopic appearance of Aspergillus fumigatus shows uniseriate phialides with columnar conidial heads and flask-shaped vesicles.
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Direct microscopic examination of the KOH mount of the tissue showed a mass of dichotomous branching hyphae (Figure 3A). The culture of biopsied tissue onto Sabouraud dextrose agar for 1-day incubation at 27 C yielded Aspergillus species (Figure 3B). The microscopic evaluation of the grown Aspergillus colonies showed uniseriate phialides with columnar conidial heads and flask-shaped vesicles (Figure 3C).