Dehiscence of a Mechanical Aortic Valve Secondary to Culture-Negative Endocarditis Complicated by Acute Heart Failure

Figures

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  Figure 1. Plain posterior-anterior chest radiograph obtained in the emergency department on the day of presentation. There is interstitial pulmonary edema, without evident cardiomegaly. A permanent pacemaker is in situ with a single right ventricular lead.

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  Figure 2. Initial transthoracic echocardiogram. The mechanical AV prosthesis in parasternal long axis view. Early diastole. There is mild AR. LA, Left atrium.

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  Figure 3. Transesophageal echocardiogram performed day 14 of admission. Short-axis three-dimensional image in end-systole showing dehiscence of aortic prosthesis in 3 o'clock to 6 o'clock position (A, B) and resultant paravalvular leak (B). (C) Long-axis view demonstrating separation of the aortic prosthesis from the aortomitral curtain. The valve is seen rocking (see Video 3C). LA, Left atrium; mAV, mechanical AV; MV, mitral valve; RA, right atrium.

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  Figure 4. Day 3 after excision of mechanical aortic prosthesis and replacement with an AV homograft. The valve is functioning normally, with only trivial AR (see Video 4).

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  Figure 5. Computed tomographic chest axial plane at the level of the AV (A) and coronal plane (B) demonstrating presence of pseudoaneurysm (asterisk) and connection to the LV outflow tract (B). LA, Left atrium.

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  Figure 6. Transesophageal echocardiogram before repair of homograft pseudoaneurysm shown in end-systole in short axis (A) and long axis (B). Collapse of noncoronary cusp (NCC) of AV homograft by systolic flow through the pseudoaneurysm (asterisk). LA, Left atrium; RA, right atrium.

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  Figure 7. Bovine patch repair of pseudoaneurysm with access via the pseudoaneurysmal sac (asterisk). The mouth of the pseudoaneurysm is depicted by the arrow. AscAo, Ascending aorta.