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A 58-YEAR-OLD man developed transient monocular visual loss in the right lower quadrant
of the left eye that fully resolved in less than 24 hours. He was afebrile and had
no other symptoms. His known medical history included well-controlled arterial hypertension
and dyslipidemia. He denied a history of cerebrovascular disease, atrial fibrillation,
intravenous drug use, and thromboembolic disease. Medical evaluation included a carotid
Doppler ultrasound that showed no abnormality, an unremarkable brain magnetic resonance
imaging (MRI) examination, an unremarkable ophthalmologic examination, and a normal
white blood cell count. A transesophageal echocardiographic (TEE) examination was
performed and showed moderate mitral regurgitation in the setting of bileaflet prolapse.
Additionally, an 8 × 7 mm mass was found to be attached to the atrial side of the
anterior leaflet of the mitral valve (Fig 1, Fig 2 and Videos 1 and 2 [supplementary videos are available online]). The patient was scheduled for mitral
valve reconstructive surgery and mass resection 3 weeks after his medical evaluation
had been completed. What is the diagnosis?
Fig 1Real-time 3-dimensional TEE “zoom mode.” A mass is seen on the A3 segment.
