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Two-dimensional transesophageal echocardiography (TEE) in the midesophageal, long-axis view (left) demonstrated aortic valve thickening (double white arrows) and an anterior mitral leaflet mass (single white arrow) consistent with vegetations and endocarditis. Color doppler TEE (right) showed a torrential regurgitant aortic jet directly striking the anterior mitral leaflet (black arrow), causing premature middiastolic rebound into the left ventricular inflow tract and a middiastolic (Austin Flint) murmur. The Austin Flint phenomenon represents a potential pathophysiological mechanism for bivalvular infection in this patient if his aortic valve endocarditis secondarily seeded his mitral valve via a regurgitant aortic jet.
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