PMC4659949_01
(a) shows the large vegetation on the P2 scallop of the posterior mitral valve on 2D TEE. (b) Corresponding mass noted on RT-3DTEE.
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While the patient was getting appropriate antibiotics, on day 12, he developed an acute pulmonary edema and new onset of atrial fibrillation with rapid ventricular rate. 2D-transesophageal echo revealed a much larger vegetation (Figure 1(a)) measuring 2.3 cm on the P2 scallop of the posterior leaflet of the mitral valve and severe MR. Real Time 3D Transesophageal Echocardiography (RT-3D TEE) confirmed a large vegetation on the P2 scallop of the posterior mitral leaflet (Figure 1(b)).
Color 3D TEE image on an Apical 4 Chamber view shows the impressive lateral jet (red arrow) originating from the perforation on the P2 scallop of posterior mitral leaflet. The less impressive central jet of mitral regurgitation is partially seen in this image (yellow arrow).
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Color 3D Doppler revealed two mitral regurgitation jets in the left atrium, one jet with a central origin and one jet that was lateral (Figure 2), and we were able to easily identify a perforation in the P2 scallop of the posterior mitral leaflet with an estimated area of 0.8 cm.
The red arrows on RT-3DTEE (a) and intraoperative image of the mitral valve (b) showing the perforation in the P2 scallop of the posterior mitral leaflet (AML: anterior mitral leaflet; PML: posterior mitral leaflet).
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Intraoperatively, the perforation size and location on the P2 scallop of the posterior mitral valve (Figure 3(a)) exactly matched the preoperative 3D TEE findings (Figure 3(b)).