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European Journal of Echocardiography Advance Access originally published online on March 9, 2007
European Journal of Echocardiography 2008 9(3):395-396; doi:10.1016/j.euje.2007.01.003
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org

Multiple pseudo-abscesses following aortic valve replacement

M.N. Attar*, R.K.G. Moore and S. Khan

Department of Cardiology, Royal Preston Hospital, Sharoe Green Lane, Preston, Lancashire PR2 5HT, UK

Received 14 December 2006; accepted after revision 12 January 2007; online publish-ahead-of-print 9 March 2007.

* Corresponding author: 22 St. Gregory Road, Preston, Lancashire PR1 6YB, UK. Tel: +44 7981 925 483/1772 466787; fax: +44 1772 522948. E-mail address: nadattar{at}hotmail.com (M.N. Attar).


   Abstract
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 Abstract
Case report
 
Prosthetic aortic valve endocarditis is associated with valve ring abscess, conduction abnormalities and a grave prognosis. Aortic root abscess is a serious complication of infective endocarditis with high mortality. We report a case of a patient who had echocardiographic features resembling aortic root abscess along with severe aortic regurgitation, 6 weeks following aortic valve replacement. Valvular dehiscence led to perivalvular abscess like appearance. Infective endocarditis was exluded. He underwent a successful redo aortic valve surgery with slow recovery.

Keywords: Valvular dehiscence; Aortic root abscess; Pseudo-abscess; Aortic valve replacement


   Case report
Top
 Abstract
 Case report
 
A 59-year-old Caucasian male presented with recent onset post-prandial angina. He had a strong family history of premature coronary artery disease. Severe aortic regurgitation with good left ventricular systolic function was found on echocardiogram. Coronary angiography showed 90% stenosis in the left anterior descending artery and also significant lesions in the first diagonal, left circumflex and right coronary arteries. Root aortogram confirmed severe aortic regurgitation. He underwent quadruple bypass and aortic valve replacement with a 25-mm Sorin Fitline mechanical valve. He made a good postoperative recovery and was free from angina. At 6-week follow-up, cardiac examination revealed metallic second heart sound and, unexpectedly, an early diastolic murmur. Severe aortic regurgitation was noted on repeat echocardiogram. Trans-oesophageal echocardiography was then undertaken. Mid-oesophageal short-axis view shows prosthetic aortic valve ring in the centre (Figures 1 and 2). Multiple cavities suggestive of perivalvular abscesses are seen. However, he was afebrile and there were no peripheral stigmata of infective endocarditis. FBC, ESR and CRP were normal. Blood cultures were negative. Although he was asymptomatic, redo aortic valve replacement was considered in view of the severe aortic regurgitation. He underwent redo aortic valve surgery with aortic valve replacement and made a slow recovery. Culture of the excised aortic valve was negative, ruling out endocarditis. Valvular dehiscence and cavities separated by suture lines led to the dramatic resemblance to perivalvular abscesses.


Figure 1
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  		Figure 1 Mid-oesophageal short-axis view. Broken arrows indicate pseudo-abscess, solid arrow, the area of valvular dehiscence and arrowhead, the aortic valve ring.

 


Figure 2
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  		Figure 2 Mid-oesophageal short-axis view magnified with zoom.

 

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This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
9/3/395    most recent
j.euje.2007.01.003v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
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Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
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Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Attar, M.N.
Right arrow Articles by Khan, S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Attar, M.N.
Right arrow Articles by Khan, S.
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What's this?