PMC9618835_01
Initial chest X-ray.
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The chest radiograph revealed bilateral airspace opacities predominantly extending from the left hilum to the left upper and lower lung fields (Fig. 1).
Transthoracic echocardiography apical 2 chamber view. At least moderate mitral regurgitation with possible abnormal mitral valve morphology is noted. (in color) White arrowhead, indicating indistinct abnormal mitral valve morphology. Purple arrowhead, at least moderate mitral regurgitation. (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)
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Transthoracic echocardiography (TTE) revealed a hyperdynamic ejection fraction of 70-75%, moderate regurgitation of the aortic valve and moderate regurgitation of mitral valve with abnormal valvular morphology (Fig. 2a, Fig. 2b, Videos).
Apical 3 chamber view. At least moderate mitral regurgitation is redemonstrated, and there is evidence of turbulent flow across the aortic valve. (in color) Purple arrowhead, indicating at least moderate mitral regurgitation. White arrowhead, indicating turbulent flow across the aortic valve. (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)
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Transesophageal echocardiogram (TEE) displayed moderate to severe regurgitation in the aortic valve and clarified that mitral regurgitation was due to severe flail motion involving the anterior leaflet with wide-open regurgitation (Fig. 3a, Fig. 3b, Video).
Transesophageal echocardiography at 120 . White arrowhead, indicating flail motion of the anterior leaflet. Purple arrowhead, indicating thickening and calcification of the aortic valve. (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)
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The reconstructed CT Chest demonstrated four pulmonary veins draining into the left atrium (Fig. 4a, Fig. 4b).
Transesophageal echocardiography view at 70 . White arrowhead, indicating mitral regurgitation vena contracta (narrowest portion of regurgitant flow). Purple arrowheads, indicating mitral regurgitant jet area. Green arrow, indicating the direction of flow and its orientation towards the left sided pulmonary veins. White star, indicating regurgitant flow into the left upper pulmonary vein. (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)
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The Cardiac CT 12 months after the valve replacement showed well seated bioprosthetic valve in mitral position (Fig. 5).