Article Text

Fifty-seven-year-old man with progressive dyspnoea
  1. Nikoloz Koshkelashvili,
  2. Priya Kohli,
  3. Jason Linefsky
  1. Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
  1. Correspondence to Dr Nikoloz Koshkelashvili, Division of Cardiology, Emory University School of Medicine, Atlanta, GA 30322, USA; nkoshke{at}


Clinical introduction A 57-year-old man from the USA with a history of atrial fibrillation and hypertension was evaluated for progressive dyspnoea and decreased energy. The patient denied a history of congestive heart failure, systemic symptoms or myocardial infarction. He was found to have a 3/6 holosystolic murmur radiating to the axilla. Transthoracic echocardiography (TTE) reported a reduced ejection fraction of 40%, mitral valve regurgitation and absence of interatrial shunts. The remaining cardiac valves were without abnormality. A nuclear stress test reported 18% fixed inferolateral defect. Subsequent coronary angiography was negative for obstructive coronary artery disease. To better evaluate the mitral valve apparatus, transoesophageal echocardiography (TEE) was performed.

Question Which of the following best explains the TEE findings (figure 1) of the mitral valve?

  1. Carcinoid heart disease.

  2. Drug-induced valvular heart disease.

  3. Infective endocarditis.

  4. Ischaemic mitral regurgitation (MR).

  5. Rheumatic mitral valve disease.

Figure 1

(A) Transoesophageal echocardiography (TEE) mid-oesophageal view at 94° during diastole. (B) TEE mid-oesophageal view at 94° during systole. (C) TEE mid-oesophageal view at 0° with colour Doppler. (D) TEE 3D view of the mitral valve from the left atrium.

  • mitral valve
  • mitral regurgitation
  • echocardiography
  • valvular heart disease

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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