case_images: PMC5374812_01
case_images: Midesophageal long-axis view showing thickened and calcified mitral valve with smoke in left atrium and turbulent flow across the valve (LA: Left atrium, LV: Left ventricle, Ao: Aorta)
case_images: JOACP-33-117-g001.jpg
case_images: PMC5374812_01_JOACP-33-117-g001.jpg
case_images: F1
case_images: Intraoperative transesophageal echocardiography (TEE) confirmed the preoperative TTE findings of a severely thickened and calcified MV with a valve area of 0.6 cm2 and the presence of spontaneous echo contrast in LA [Figure 1].
case_images: Modified midesophageal four-chamber view showing normal functioning bileaflet prosthesis valve in situ in closed (a) and open (b) position. Note the absence of thrombus in left atrium
case_images: JOACP-33-117-g002.jpg
case_images: PMC5374812_01_JOACP-33-117-g002.jpg
case_images: F2
case_images: TEE and no apparent thrombus was observed in any heart chamber [Figure 2].
case_images: Modified aortic valve short-axis view showing thrombus in left atrium, aorta and right atrium
case_images: JOACP-33-117-g003.jpg
case_images: PMC5374812_01_JOACP-33-117-g003.jpg
case_images: F3
case_images: TEE revealed thrombi in all the chambers of the heart and aortic root [Figure 3]. The surgeon could not palpate the femoral pulses bilaterally.