PMC8105625_01
a. Mitral valve annulus dilation (38 mm - dotted line). b. Ruptured chordae prolapsing onto the left atrium (red arrow signals the prolapsed chordae). c. Posterior leaflet prolapsed. d. Posterior leaflet prolapses with suspected vegetations images. e. Excised mitral valve showing multiple vegetations on the auricular surface of the leaflets (red arrows). The green arrow shows the first order ruptured tendinous cord corresponding to the P2 prolapse. f. Ventricular Surface of the excised mitral valve.
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A trans-esophageal echocardiogram (TEE) was performed which showed relevant findings on the mitral valve: a moderate to severe insufficiency, prolapse of the posterior leaflet (due to a tendinous cord rupture) and images of a suspected vegetation (size: 10 x 2 mm) at the posterior on the P2 scallop (Fig. 1a, b, c, d: Trans-esophageal ultrasound image). Cultures of the mitral valve (after 14 days of treatment with ceftazidime-avibactam) remained negative but the surgical specimen showed clear signs of endocarditis (Fig. 1e, f: Surgical specimen of the mitral valve).