PMC9433712_01
Brain MRI. (A,B) T1 and T2 sequences showing cerebral infarction with a clear border in the right cerebellar hemisphere (arrow). (C,D) T1 and T2 sequences showing cerebral infarction with a clear border in the right thalamus. MRI, magnetic resonance imaging (arrow).
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F1
Magnetic resonance imaging (MRI) of the brain was then performed, showing multiple infarctions and softening lesions in the right thalamus, paraventricular area, and cerebellar hemisphere (Figure 1).
(A,C) Transthoracic echocardiography showing thickened mitral valve leaflets with verrucous, nodular, heterogeneous echoic vegetations located on the commissural border of both leaflet tips (arrows). (B,D) Color Doppler imaging revealing mild to moderate mitral regurgitation (arrow). AO, aorta; LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle; TTE, transthoracic echocardiography.
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F2
Additionally, verrucous and nodular vegetations with heterogeneous echo-density could be seen at the commissural border of both mitral valve leaflets (Figures 2A,C). Mild to moderate mitral regurgitation was detected at the central commissure when the valve closed (Figures 2B,D) with an effective regurgitant orifice area (EROA) of 0.25 cm2 and the regurgitant volume of 36 mL.
(A,C) Follow-up transthoracic echocardiography (TTE) demonstrating thickening and hyperechoic lesions of mitral valve leaflets (arrows), suggesting valvular fibrosis. (B,D) Color Doppler imaging showing moderate to severe regurgitation of the mitral valve. AO, aorta; LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle; TTE, transthoracic echocardiography.
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F3
TTE showed thickening and fibrosis of the anterior and posterior mitral valve cusps, mild stenosis (transmitral mean gradient of 3 mmHg and mitral valve area of 2.6 cm2) and moderate to severe regurgitation of the mitral valve (Figure 3) with EROA of 0.40 cm2 and the regurgitant volume of 58 mL.
Histopathology of excised valve demonstrating fibrous tissue hyperplasia with hyaline degeneration and no inflammatory cell infiltration.
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Histopathology demonstrated fibrous tissue hyperplasia with hyaline degeneration and no inflammatory cell infiltration (Figure 4).