Fig. 2

Images C and D: A 54-year-old female with a mechanical mitral valve replacement in 2012 for severe mitral stenosis secondary to rheumatic fever. In April 2020, the patient presented acutely with fever and night sweats. Blood cultures were positive for Staphylococcus aureus. Transthoracic echocardiography identified a stable in-situ mechanical mitral valve with good occluder mobility. There was turbulent forward flow (* in image C) and significantly elevated transvalvular mean gradient of 15 mmHg (documented as 3.3 mmHg on transthoracic echocardiography 13 months prior). There was a linear mobile mass (* in image D) on the left ventricular size of the mechanical valve replacement which was not visible on previous imaging. There was a high suspicion of infective endocarditis which was confirmed on a subsequent transesophageal echocardiography. The patient was commenced on antibiotic therapy, re-do mitral valve replacement was undertaken 16 weeks later, after which the patient made a good and uneventful recovery. At last follow-up, there was a stable in-situ mechanical mitral valve replacement, mean gradient: 3.4 mmHg, normal left ventricular size and systolic function, biplane ejection fraction: 59%. The patient was asymptomatic without any reduction in exercise tolerance. The patient remains on 12 monthly follow-up. LV: left ventricle, LA: left atrium, Ao: aorta