Key result
TEE and tissue molecular sequencing identify aortic valve rupture and culture-negative IE despite negative initial tests.
Why the study?
This report aims to summarize diagnostic challenges, imaging-based differentiation, and microbiological strategies in a rare case of aortic valve annular rupture secondary to culture-negative infective endocarditis.
Case Report (n=1)
This case highlights the importance of transesophageal echocardiography and early tissue molecular sequencing in diagnosing rare valvular abnormalities and culture-negative infective endocarditis.
Raises suspicion for annular rupture in culture-negative endocarditis; leaves open standardized diagnostic protocols.
We report a rare case of aortic valve annular rupture secondary to culture-negative infective endocarditis. This report aims to summarize the diagnostic challenges, imaging-based differentiation, and microbiological strategies, serving as a reference for similar clinical scenarios. The patient presented with progressively worsening palpitations and chest tightness. Initial transthoracic echocardiography (TTE) suggested a unicuspid aortic valve, but subsequent transesophageal echocardiography (TEE) revealed an aortic valve annular rupture with severe regurgitation. The patient exhibited signs of infection, but both blood cultures and sputum bacteriology tests were negative. Surgical exploration revealed infective changes in the valve annulus; combined with valve pathology and second-generation gene sequencing results, the diagnosis of culture-negative infective endocarditis was confirmed according to the 2023 Duke-ISCVID (Duke-International Society of Cardiovascular Infectious Diseases) criteria. This case posed diagnostic challenges due to the transthoracic echocardiographic appearance mimicking a unicuspid aortic valve and the negative routine microbiological tests. It underscores the importance of promptly performing transesophageal echocardiography when encountering suspected rare valvular abnormalities. For suspected infective endocarditis (IE) with negative routine microbiological tests, early tissue molecular sequencing should be performed to clarify the pathogen.
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Hua et al. (2026) conducted a case report in Aortic valve annular rupture secondary to culture-negative infective endocarditis (n=1). Transesophageal echocardiography (TEE) and tissue molecular sequencing vs. Transthoracic echocardiography (TTE) and routine microbiological tests was evaluated on Diagnosis of culture-negative infective endocarditis and aortic valve annular rupture. Transesophageal echocardiography and tissue molecular sequencing successfully identified aortic valve annular rupture and culture-negative infective endocarditis after initial tests were negative.
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