Figure 2.

Two-dimensional TEE demonstrates a soft thrombotic mass (arrow) attached to the hinge of the prosthesis (a). Real-time three-dimensional transesophageal echocardiography from the left atrial side revealed thrombus (arrows) on the prosthetic mitral valve (a’). The thrombus burden was diminished (arrow) after an initial dose of TT (25 mg TPA), shown by 2-D TEE (b) and 3-D TEE (b’). After the second dose of TT, the thrombus size was completely lysed, shown by 2-D TEE (c) and 3-D TEE (c’).

LA - left atrium; LAA - left atrial appendage; LV - left ventricle; TEE - transesophageal echocardiography; tPA - tissue-type plasminogen activator; TT - thrombolytic therapy