Transthoracic versus transesophageal echocardiography

The apical four-chamber view from a transthoracic echocardiogram demonstrates only subtle changes in the posterior leaftlet of the mitral valve (arrow). However, the transesophageal echocardiogram (panel B) shows that the posterior leaflet of the mitral valve (pML) is both flail and attached to a vegetation. The anterior leaflet, which had a bright density on transthoracic echocardiography (red arrow), is normally postitioned and of normal thickness; the bright density is seen on the transesophageal echocardiogram to be the rough edge of the valve where the chordae attach (red arrow).