PMC6704374_01
Portable AP chest x-ray obtained on re-presentation with massive hemoptysis (five years after valvuloplasty) demonstrating a moderate right pleural effusion (black arrow) and right mid- and lower-lung opacities obscuring the right hemidiaphram and right heart border. Vascular congestion can be seen with cephalization of the vascular pattern (red arrows). The left hemidiaphragm is clear while the left heart boarder is silhouetted with a suggestion of air bronchograms in the lingula (blue arrow). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
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Shortly after admission, she was intubated for life-threatening hemoptysis, at which time her chest x-ray demonstrated unilateral signs of heart failure, including increased prominence and cephalization of the pulmonary arteries, silhouetting of the cardiac borders, and a right-sided effusion and infiltrates obscuring the right hemidiaphragm (Fig. 1).
Transesophageal echocardiographic apical four-chamber view of the heart upon re-presentation with massive hemoptysis (five years after initial mitral balloon valvuloplasty), which demonstrates left atrial dilatation. Continuous Doppler across the mitral valve exhibits elevated transvalvular gradients (red arrow), consistent with mitral stenosis. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
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A TTE showed anterior and posterior mitral valve leaflet thickening and fusion of the commissures causing severely restricted movement; estimated mitral valve peak gradient was 47 mmHg, mean gradient was 21 mmHg (Fig. 2), and mitral valve area had fallen to 0.5 cm2.