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The recent history of multiple cerebral infarcts combined with the current ocular findings prompted a transoesophageal echocardiogram which successfully revealed caseous calcification of the mitral valve annulus as the source of the numerous sequential emboli, a finding which the conventional transthoracic echocardiogram had failed to disclose as a result of suboptimal image quality. Transoesophageal echocardiography should always be considered as part of the diagnostic workup of retinal arterial occlusive disease, particularly in bilateral lesions, due to its higher yield in identifying posteriorly located cardiac valvular and aortic lesions.<\/jats:p>","DOI":"10.1136\/bcr-2018-224322","type":"journal-article","created":{"date-parts":[[2018,7,18]],"date-time":"2018-07-18T12:26:56Z","timestamp":1531916816000},"page":"bcr-2018-224322","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Caseous calcification of the mitral valve annulus: a rare cause of bilateral cerebral and ocular embolisation"],"prefix":"10.1136","volume":"2018","author":[{"given":"Artemis","family":"Matsou","sequence":"first","affiliation":[{"name":"2nd Department of Ophthalmology, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chrysanthos","family":"Symeonidis","sequence":"additional","affiliation":[{"name":"2nd Department of Ophthalmology, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Dermenoudi","sequence":"additional","affiliation":[{"name":"2nd Department of Ophthalmology, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vasileios","family":"Sachpekidis","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Papageorgiou General Hospital, Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,7,18]]},"reference":[{"key":"2025082722202313000_2018.jul18_1.bcr-2018-224322.1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.54.3.674"},{"key":"2025082722202313000_2018.jul18_1.bcr-2018-224322.2","doi-asserted-by":"crossref","first-page":"733","DOI":"10.2147\/OPTH.S56568","article-title":"Sequential bilateral retinal artery occlusion","volume":"8","author":"Padr\u00f3n-P\u00e9rez","year":"2014","journal-title":"Clin Ophthalmol"},{"key":"2025082722202313000_2018.jul18_1.bcr-2018-224322.3","doi-asserted-by":"publisher","DOI":"10.1177\/014107689508800716"},{"key":"2025082722202313000_2018.jul18_1.bcr-2018-224322.4","doi-asserted-by":"crossref","unstructured":"Wray SH . 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