Fig. 3

Pre-thrombus echocardiographic images of apical 4 chamber view of bioprosthetic mitral valve. Pre-thrombus transthoracic echocardiogram (TTE) and images of the bioprosthetic mitral (MV) valve in end-diastole demonstrating severely thickened and restricted leaflet motion in the (A) apical 4 chamber view without color Doppler, (B) apical 4 chamber view with color Doppler showing flow acceleration at the level of the MV annulus and (C) continuous wave Doppler tracing with dense envelope with mean gradient of 21 mmHg by velocity-time-integral at a heart rate of 70 beats per minute