PMC9868127_01
(A) Transthoracic echocardiogram showed a large, mobile vegetation on the ventricular side of the prosthetic valve (white arrow). (B) A vegetation was also visible on the tricuspid valve (white arrow). (C) Transthoracic echocardiogram reexamination showed residual vegetations on prosthetic aortic valves with reduced size (white arrow). (D) The new mitral valve moderate regurgitation. LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle.
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F1
Transthoracic echocardiogram (TTE) revealed a large (25 mm x 22 mm), iso-echogenic, irregular vegetation on the ventricular side of the prosthetic aortic valve (Figure 1A) winging back and forth during the cardiac cycle. In addition, a large (16 mm x 9 mm) tricuspid valve vegetation with obvious mobility was also presented (Figure 1B). He underwent a TTE reexamination on day 31, showing that aortic valve and tricuspid valve vegetations were still present while the aortic valve vegetation was smaller compared with the last time (Figure 1C). However, a new mitral valve regurgitation has emerged (Figure 1D).
(A) Vascular ultrasonography showed hypoechoic filling echo was seen at the distal end of the right common femoral artery. (B) Color Doppler image displayed there was little color blood flow signal. (C) Abnormal spectrum morphology of posterior tibial artery with the significantly reduced blood flow velocity. (D) Multiple filling defects of the right femoral artery were observed in three-dimensional reconstruction (red arrow). (E) Enhanced CT scanning revealed a low-density lesion in the left occipital lobe (red arrow). (F) Abdominal enhancement CT showed wedge-shaped hypodense lesions under the capsule with no enhancement (white arrow). T, thrombus.
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F2
The vascular ultrasound showed hypoechoic mass at the distal end of the right common femoral artery with a size of 38 mm x 11 mm without significant activity (Figure 2A), strongly suggesting right common femoral artery embolism, one of the complications of PVE. Color Doppler showed scattered color blood flow signal (Figure 2B) and delayed upstroke waveforms (Figure 2C). The embolism in the right femoral artery was also confirmed by enhanced CT reconstruction (Figure 2D). Enhanced CT scanning revealed left occipital cerebral embolism (Figure 2E). Furthermore, the patient developed abdominal pain, and the CT scan revealed splenic infarction (Figure 2F) on day 40.
(A) Thrombotic substance and vegetations removed by surgery in gross appearance (white arrow: thrombotic substance; black arrow: vegetation). (B) Fiber-like substance and many red blood cells were seen under the microscope (H&E staining; magnification, x10). H&E, hematoxylin and eosin.
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F3
Macroscopic inspection revealed thrombotic substance and vegetations (Figure 3A). Fiber-like material and red blood cell aggregation were shown under the microscope (Figure 3B).