October 2023
INTERESTING ECHO OF THE MONTH
Case History
A 70 year male patient was referred for trans esophageal echo. Patient had undergone Aortic valve replacement 6 months before. He had presented to a peripheral hospital with a stroke. On enquiry there was a history of low grade fever for 2 months What is the Diagnosis??
S/P AVR - Bio- prosthetic in aortic position. Evidence of large mobile vegetation with multiple satellite lesion, abscess formation and sub aortic aneurysm formation at mitro-aortic curtain is noted. There is a communication of this sac with the aortic valve posteriorly. Vegetation is so large as to be causing valve stenosis. PG / MG = 77/51 mm Hg). There is a mild AR. Blood culture revealed a fungal etiology.
The ME 4 chamber 0 degree view shows there is a large mobile vegetation on bio prosthetic aortic valve. The ME long axis 120 degree view shows there is abscess formation with sub aortic aneurysm formation at mitro- aortic curtain ( arrow shown) .The ME long axis 130 degree color compare view shows communication of this sac with the aortic valve posteriorly ( arrow shown).