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A 23-year-old man underwent mechanical bi-leaflet implant following infective endocarditis of native trileaflet aortic valve. He developed sustained runs of ventricular tachycardia (VT) (left bundle branch block (LBBB) morphology) 5 days postoperatively with loss of cardiac output needing external electrical cardioversion. Physical examination revealed an ejection systolic murmur in the aortic area (grade 2/6) and a pan-systolic murmur (grade 4/6) along the left sternal edge with raised jugular venous pressure. Routine blood tests demonstrated leucocytosis and a raised C reactive protein, and chest radiography showed pulmonary oedema. Transoesophageal echocardiography (TOE) was performed (figure 1).
Based on these images and the clinical data the most likely …