Key result
Serial multimodal imaging detects occult perivalvular abscess despite vegetation regression in endocarditis.
Why the study?
Prosthetic valve endocarditis carries substantial mortality, and perivalvular infection may progress insidiously even during antimicrobial treatment.
Case Report (n=1)
Antibiotic-induced vegetation regression in prosthetic valve endocarditis can mask progressive perivalvular abscess formation, underscoring the need for serial multimodal imaging with TTE, TEE, and cardiac CTA.
Vegetation regression on TTE does not exclude perivalvular progression in PVE; leaves open need for serial TEE monitoring.
Background Prosthetic valve endocarditis (PVE) is associated with substantial mortality. Perivalvular infection may progress insidiously even during antimicrobial treatment. Case Presentation A 61-year-old female patient developed Staphylococcus aureus PVE two years after mechanical aortic valve replacement. Initial transthoracic echocardiography (TTE) identified a left ventricular outflow tract vegetation, which regressed following treatment with vancomycin and moxifloxacin. Nevertheless, the patient later suffered an acute ischemic stroke. Sequential multimodal imaging demonstrated a progressively expanding perivalvular lesion. Transesophageal echocardiography (TEE) and cardiac computed tomography angiography (CTA) confirmed a giant left coronary sinus pseudoaneurysm with pericardial abscess invasion. Emergency surgical repair of the pseudoaneurysm and paravalvular leak was performed, and histopathology verified active suppurative infection. Conclusion Antibiotic-induced vegetation regression can conceal ongoing perivalvular abscess progression. Serial multimodal surveillance using TTE, TEE, and CTA is critical for early detection of occult complications in PVE, facilitating timely surgical intervention.
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Tang et al. (2026) conducted a case report in Staphylococcus aureus prosthetic valve endocarditis (n=1). Vancomycin and moxifloxacin, serial multimodal imaging (TTE, TEE, CTA), and emergency surgical repair was evaluated on Detection and surgical repair of giant left coronary sinus pseudoaneurysm with pericardial abscess invasion. Serial multimodal imaging (TTE, TEE, CTA) in 1 patient (61 years old) detected an occult giant perivalvular abscess despite antibiotic-induced vegetation regression, enabling emergency surgery.
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