{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T12:39:48Z","timestamp":1773319188307,"version":"3.50.1"},"reference-count":0,"publisher":"Pakistan Medical Association","issue":"03","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Pak Med Assoc"],"abstract":"<jats:p>Vegetations on the high-pressure side of the mitral valve, particularly the chordae tendineae, are rare. We report two cases of infective endocarditis (IE) with atypical presentations. Case 1: A 34-year-old male with pulmonary aspergilloma, who presented with fever and respiratory distress. Blood cultures grew Staphylococcus species, and echocardiography revealed a 16 \u00d7 8 mm vegetation on the mitral valve chordae. Surgery was deferred due to disseminated fungal infection, and the patient improved with antimicrobial therapy. Case 2: A previously healthy 36-year-old male presented with fever, vomiting, dyspnoea, and headaches. Blood cultures were positive for Methicillin-resistant Staphylococcus aureus (MRSA), and echocardiography detected a 13 \u00d7 7 mm vegetation on the mitral valve chordae. The patient responded well to intravenous antibiotics, with complete resolution on follow-up. These cases highlight the need for high clinical suspicion, thorough imaging, and individualised management strategies in atypical presentations of infective endocarditis.\nKeywords: Infective endocarditis, Chordae vegetation, Echocardiography, Staphylococcus species, Fungal endocarditis, Valve dysfunction.<\/jats:p>","DOI":"10.47391\/jpma.22809","type":"journal-article","created":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T18:58:22Z","timestamp":1772391502000},"page":"427-431","source":"Crossref","is-referenced-by-count":0,"title":["Vegetation on the chordae and papillary muscle of the mitral valve: a diagnostic and therapeutic enigma"],"prefix":"10.47391","volume":"76","author":[{"given":"Rizwan Ali","family":"Khawaja","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"family":"Muhammad Ahmed Tamiz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"family":"Fateh Ali Tipoo Sultan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"26547","published-online":{"date-parts":[[2026,3,1]]},"container-title":["Journal of the Pakistan Medical Association"],"original-title":[],"link":[{"URL":"https:\/\/jpma.org.pk\/index.php\/public_html\/article\/download\/22809\/4660","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/jpma.org.pk\/index.php\/public_html\/article\/download\/22809\/4660","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T18:58:33Z","timestamp":1773255513000},"score":1,"resource":{"primary":{"URL":"https:\/\/jpma.org.pk\/index.php\/public_html\/article\/view\/22809"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,1]]},"references-count":0,"journal-issue":{"issue":"03","published-online":{"date-parts":[[2026,3,1]]}},"URL":"https:\/\/doi.org\/10.47391\/jpma.22809","relation":{},"ISSN":["0030-9982","0030-9982"],"issn-type":[{"value":"0030-9982","type":"electronic"},{"value":"0030-9982","type":"print"}],"subject":[],"published":{"date-parts":[[2026,3,1]]}}}