A 78-year-old male with a history of hypertension and hypercholesterolaemia was admitted to hospital with acute left eye visual loss and diagnosed with retinal artery occlusion. Magnetic resonance imaging (MRI) revealed multiple, bilateral cerebral infarcts involving supra- and infra-tentorial brain consistent with acute ischaemic stroke from a central embolic source. Extended ambulatory electrocardiographic monitoring displayed sinus rhythm with no evidence of atrial flutter or fibrillation. Transthoracic echocardiography (TTE) revealed a cystic structure associated with the mitral valve, with no restriction or regurgitation. Left ventricular function was preserved with no evidence of apical thrombus. Characterisation with transesophageal echocardiography (TOE) demonstrated the cystic mass encapsulated within the anterior leaflet of the mitral valve at the posteromedial commissure which was well circumscribed with no independent motion or surface irregularities (Figure 1). Infective endocarditis or abscess were thought unlikely given there were no systemic infective symptoms and normal inflammatory markers. TOE, in conjunction with arterial phase computerised tomography (CT) imaging, additionally revealed mild–moderate aortic arch atheroma but no other abnormalities of possible embolic source.
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Published online: February 16, 2023
Accepted: January 15, 2023
Received in revised form: January 2, 2023
Received: July 10, 2022
© 2023 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.