A 58 year old woman with a one year history of antiphospholipid syndrome and ineffective anticoagulant treatment (international normalised ratio 1.2) was admitted with pain in the left hypochondrium. Abdominal ultrasound revealed a 5 cm wide splenic infarction. Transoesophageal echocardiography showed mobile masses resembling bunches of grapes on both the mitral and the tricuspid valves (panels A and B, and video 1—to view video footage go to http://www.heartjnl.com/supplemental). On control transoesophageal echocardiography after six weeks of effective anticoagulation, these masses almost entirely disappeared from both valves (panel C and video 2). The patient showed no signs or symptoms of embolism during the same period.
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