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A 41 year old female intravenous drug user, with a remote history of a mechanical St Jude aortic valve replacement, was admitted to our institution with a 10 day history of fever, chills, malaise, haematuria, altered mental status, and embolisation to the lower extremities, kidney, and brain.
Blood cultures were positive for methicillin sensitive Staphylococcus aureus and the patient was started on nafcicillin, gentamycin, and rifampin.
A transoesophageal echocardiogram was performed revealing severe aortic insufficiency and a large aortic root abscess with dehiscense of the mechanical aortic, and multiple vegetations in the left ventricular outflow tract (arrowed below) simulating native AV leaflets movement during the cardiac cycle. The left hand panel shows a large area between the mechanical aortic valve (arrow head) and the left atrium (LA) with multiple heterogenic echodensities, consistent with a 3.5 cm. diameter intervalvar fibrosa and aortic root abscess. The right hand panel shows the mechanical aortic valve (arrow head) has been displaced by the aortic root abscess with resultant prosthetic valve dysfunction and severe aortic insufficiency.
The patient died before surgery was attempted.