case_images: PMC11830191_01
case_images: Transthoracic echocardiography images. (A) Vegetation attached to the atrial side of the anterior mitral leaflet measuring 15 x 7.6 mm. (B) Significant mitral regurgitation. (C) Vegetation attached to the free edge of the anterior tricuspid leaflet measuring 21 x 12 mm. (D) Massive tricuspid regurgitation.
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case_images: The tricuspid valve had vegetation interfering with valve closure, measuring 21 x 12 mm, causing significant central tricuspid regurgitation, with a systolic pulmonary artery pressure (SPAP) at 64 mmHg (Fig. 1).
case_images: Transesophageal echocardiography images. (A) Incidence 113  showing vegetation attached to the free edge of the anterior tricuspid leaflet measuring 26.3 mm in long axis. (B) Surface area of the vegetation attached to the anterior tricuspid leaflet estimated at 2.51 cm2 and circumference of 8.06 cm. (C) Color Doppler showing significant mitral regurgitation. (D) Incidence 113  showing vegetation attached to the large mitral leaflet measuring 15 mm in long axis.
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case_images: Intraoperative images. (A) Vegetations on the anterior tricuspid leaflet. (B) Valvular suture of the mitral autograft to the native tricuspid annulus. (C) Suture of the anterior papillary muscle of the mitral autograft to the interventricular septum. (D) Tricuspid annuloplasty ring with no residual regurgitation at serum testing.
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case_images: PMC11830191_01_rjaf057f3.jpg
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case_images: Carpentier-Edwards) (Fig. 3). Cultures of the resected segments were negative.
case_images: Postoperative transthoracic echocardiography, four chambers showed at 1 month. Green arrow: mechanical mitral prosthesis in place without stenosis and without detectable leakage. White arrow: tricuspid coaptation without detectable leakage, with slight excess fabric at the suture line on the anterior tricuspid leaflet. Blue arrow: inferior tricuspid papillary muscle. Red arrow: anterior tricuspid papillary muscle.
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case_images: PMC11830191_01_rjaf057f4.jpg
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case_images: Post-operative follow-up was uneventful, and echocardiographic follow-up at discharge showed no residual tricuspid regurgitation or stenosis (Fig. 4).