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  Indian J Med Microbiol
 

Figure 1: Transthoracic echocardiogram in the acute phase. Four apical chamber section. Single large vegetation with echogenicity similar to that of the myocardium and with a small area of attachment to the atrial side of the lateral mitral valve annulus. This mass showed a rapid oscillatory movement, prolapsing into the inflow tract of the left ventricle, clearly distinct from the normal pattern of valve movement. The result was a massive mitral regurgitation due to a perforation in the posterior leaflet, in a native mitral valve with fibrocalcific degeneration

Figure 1: Transthoracic echocardiogram in the acute phase. Four apical chamber section. Single large vegetation with echogenicity similar to that of the myocardium and with a small area of attachment to the atrial side of the lateral mitral valve annulus. This mass showed a rapid oscillatory movement, prolapsing into the inflow tract of the left ventricle, clearly distinct from the normal pattern of valve movement. The result was a massive mitral regurgitation due to a perforation in the posterior leaflet, in a native mitral valve with fibrocalcific degeneration