Unexpected Findings in the Left Atrium of a Patient With a Paravalvular Mitral Leak.

Journal of Cardiothoracic and Vascular Anesthesia, Vol 29, No 6 (Decemb A41-YEAR-OLD MAN with a recent history of aortic and mitral valve replacement, due to endocarditis, presented to the authors’ hospital with a large P2 mitral paravalvular leak. The patient was taken to the cardiac catheterization laboratory, where a percutaneous antegrade trans-septal approach to the defect was attempted using fluoroscopic and transesophageal echocardiography (TEE) guidance. The procedure was suspended after several unsuccessful attempts, and the patient was scheduled for repeat mitral surgery. The patient subsequently was transported to the operating room. After induction of anesthesia and endotracheal intubation, a TEE examination confirmed the paravalvular leak. The authors also observed the images shown in Figures 1, 2, and 3 and Video clip 1. What is the diagnosis?