case_images: PMC11607125_01
case_images: Preoperative transthoracic echocardiography. Fixed medial leaflet of prosthetic mitral valve (white arrow), in comparison to the other leaflet (black arrow).
case_images: cjim-16-178-g001.jpg
case_images: PMC11607125_01_cjim-16-178-g001.jpg
case_images: F1
case_images: MV (figure 1, 2 A, B), with increased transvalvular gradients (MG: 13mmHg, EV: 2.5m/s, PHT: 135ms, and DVI: 3.4). More importantly, a relatively large (1.1*0.5cm) and partially organized immobile clot was reported, entrapped in the medial hinge point of the medial leaflet of prosthetic MV, in both atrial and ventricular sides.
case_images: Pre-pump (cardiopulmonary bypass) intraoperative transesophageal echocardiography. A) Prosthetic MV in systole (both leaflets closed) B) Prosthetic MV in diastole - fixed medial leaflet (white arrow). C) Large immobile clot (1.1*0.5cm) entrapped in the medial hinge point of the medial leaflet. D) Smaller semi-mobile clot (0.3*0.35cm) on the atrial side of the mentioned hinge point.
case_images: cjim-16-178-g002.jpg
case_images: PMC11607125_02_cjim-16-178-g002.jpg
case_images: F2
case_images: PMC11607125_02
case_images: Pre-pump (cardiopulmonary bypass) intraoperative transesophageal echocardiography. A) Prosthetic MV in systole (both leaflets closed) B) Prosthetic MV in diastole - fixed medial leaflet (white arrow). C) Large immobile clot (1.1*0.5cm) entrapped in the medial hinge point of the medial leaflet. D) Smaller semi-mobile clot (0.3*0.35cm) on the atrial side of the mentioned hinge point.
case_images: cjim-16-178-g002.jpg
case_images: PMC11607125_02_cjim-16-178-g002.jpg
case_images: F2
case_images: Cutaneous manifestations. A, B, C, and D) Generalized tan red-brown macules and patches spread all over the trunk and extremities. B) Non-healing sternotomy wound after the fourth MVR surgery.
case_images: cjim-16-178-g003.jpg
case_images: PMC11607125_04_cjim-16-178-g003.jpg
case_images: F3
case_images: The patient's physical examination revealed generalized tan red-brown macules since childhood, which were diagnosed (by skin biopsy) about a year after the first surgery, as a case of urticaria pigmentosa (UP) (figure 3).
case_images: PMC11607125_03
case_images: Timeline of the major surgeries.
case_images: cjim-16-178-g004.jpg
case_images: PMC11607125_03_cjim-16-178-g004.jpg
case_images: F4
case_images: PMC11607125_04
case_images: Cutaneous manifestations. A, B, C, and D) Generalized tan red-brown macules and patches spread all over the trunk and extremities. B) Non-healing sternotomy wound after the fourth MVR surgery.
case_images: cjim-16-178-g003.jpg
case_images: PMC11607125_04_cjim-16-178-g003.jpg
case_images: F3
case_images: The patient's physical examination revealed generalized tan red-brown macules since childhood, which were diagnosed (by skin biopsy) about a year after the first surgery, as a case of urticaria pigmentosa (UP) (figure 3).
case_images: A, B, and C) Partially filled papillary dermis by mononuclear cell, with small round nuclei and granular cytoplasm. D) Toluidine blue stain shows metachromatic granules.
case_images: cjim-16-178-g005.jpg
case_images: PMC11607125_04_cjim-16-178-g005.jpg
case_images: F5
case_images: The pathology results confirmed mastocytosis - urticaria pigmentosa (figure 5).
case_images: PMC11607125_05