case_images: PMC6142734_01
case_images: Preoperative midesophageal TEE 4-chamber view showing a large echo-dense atrial mass; one segment is attached to the atrial septum (2.67 cm x 1.43 cm) and another segment is attached to the anterior mitral leaflet (1.43 cm x 2.22 cm).
case_images: CRIC2018-2506368.001.jpg
case_images: PMC6142734_01_CRIC2018-2506368.001.jpg
case_images: fig1
case_images: The left atrial mass was further characterized by a transesophageal echocardiogram (TEE) as a solid, irregularly shaped, partly mobile mass attached to the atrial septum and extending to the anterior mitral valve leaflet (Figure 1).
case_images: Cardiac MRI first-pass perfusion imaging showing mass originating on the atrial septum and extending along the atrial aspect of the anterior mitral valve leaflet.
case_images: CRIC2018-2506368.002.jpg
case_images: PMC6142734_01_CRIC2018-2506368.002.jpg
case_images: fig2
case_images: In addition, MRI of the heart with gadolinium was done preoperatively which confirmed the circumscribed hypodense mass with speckled appearance which originated at the atrial septum and extended along the anterior mitral valve leaflet (Figure 2).
case_images: TEE 2-chamber view at hospital readmission showing severe paravalvular leak of the bioprosthetic mitral valve. 180  rotation showed leak extending along the medial aspect of the valve from the posterior to the anterior.
case_images: CRIC2018-2506368.003.jpg
case_images: PMC6142734_01_CRIC2018-2506368.003.jpg
case_images: fig3
case_images: An urgent transesophageal echocardiography demonstrated severe mitral regurgitation with paravalvular leak (Figures 3, 4, 5, and 6).
case_images: TEE 3D reconstruction showing bioprosthetic mitral valve in the short axis with paravalvular dehiscence that extends along the medial aspect of the valve from the posterior to the anterior.
case_images: CRIC2018-2506368.004.jpg
case_images: PMC6142734_01_CRIC2018-2506368.004.jpg
case_images: fig4
case_images: An urgent transesophageal echocardiography demonstrated severe mitral regurgitation with paravalvular leak (Figures 3, 4, 5, and 6).
case_images: TEE 3D reconstruction with color Doppler showing a bioprosthetic mitral valve with paravalvular leak on the short axis.
case_images: CRIC2018-2506368.005.jpg
case_images: PMC6142734_01_CRIC2018-2506368.005.jpg
case_images: fig5
case_images: An urgent transesophageal echocardiography demonstrated severe mitral regurgitation with paravalvular leak (Figures 3, 4, 5, and 6).
case_images: TEE continuous wave showing severe mitral regurgitation.
case_images: CRIC2018-2506368.006.jpg
case_images: PMC6142734_01_CRIC2018-2506368.006.jpg
case_images: fig6
case_images: An urgent transesophageal echocardiography demonstrated severe mitral regurgitation with paravalvular leak (Figures 3, 4, 5, and 6).
case_images: (a) 10x H&E, (b) 20x H&E, (c) tumor negative for p53, and (d) tumor focally positive for S100.
case_images: CRIC2018-2506368.007.jpg
case_images: PMC6142734_01_CRIC2018-2506368.007.jpg
case_images: fig7
case_images: Immunohistochemical stains demonstrated that the neoplastic cells were positive for vimentin, focally positive for S-100, and weakly positive for CDK4 and negative for p53 (Figure 7).