PMC7264758_01
Anteroposterior chest x-ray revealing an enlarged cardiac silhouette, pulmonary edema, small bilateral pleural effusions, and prosthetic mitral valve.
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Chest radiograph revealed small bilateral pleural effusions and pulmonary edema (Fig. 1).
Panel A: Transthoracic apical 4 chamber view demonstrating biatrial enlargement, right ventricular dilation, and bioprosthetic mitral valve thickness. Panel B: Magnified imaging of the bioprosthetic mitral valve encased by infective vegetative material. Panel C: Color doppler interrogation of the bioprosthetic mitral valve with turbulent and restrictive flow across the valve.
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Transthoracic echocardiogram revealed an ejection fraction between 30-35% with severe tricuspid regurgitation and bioprosthetic mitral valve thickening and hemodynamic profile consistent with obstructed valve (Fig. 2, Fig. 3), warranting transesophageal echocardiogram (TEE). The TEE showed infective vegetative material encasing the bioprosthetic leaflets, resulting in mitral valve obstruction (Fig. 4).
Panel A: Transesophageal echocardiogram, mid esophageal 4 chamber view at 60  with magnified view of the left atrium demonstrating significant spontaneous echo contrast. Panel B: 3D-reconstruction demonstrating thickened valve prosthesis and decreased orifice area.
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Transthoracic echocardiogram revealed an ejection fraction between 30-35% with severe tricuspid regurgitation and bioprosthetic mitral valve thickening and hemodynamic profile consistent with obstructed valve (Fig. 2, Fig. 3), warranting transesophageal echocardiogram (TEE). The TEE showed infective vegetative material encasing the bioprosthetic leaflets, resulting in mitral valve obstruction (Fig. 4).
Microbiology: Panel A and B revealed no growth on blood and chocolate agar at day 3. Panel C revealed pleomorphic, gram negative bacillus consistent with Cardiobacterium hominis.
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Blood cultures drawn at admission grew Cardiobacterium hominis after 4 days and speciation after 6 days (Fig. 5).