A 61-year-old man was referred for transoesophageal echocardiography (TEE) for infective endocarditis; he had had sepsis of unknown source and had undergone aortic mechanical valve replacement 6 years earlier. Two-dimensional (2D) TEE (Philips Ultrasound, iE33, Bothell, WA, USA) showed an aortic root abscess ( Fig. 1 A, arrow) around the prosthetic aortic valve (AV) on the left atrial side and also showed oscillating filaments in the left ventricular outflow tract, which were most likely vegetations originating from the prosthetic AV ( Fig. 1 A; Video 1 A). Although the TEE revealed a mobile mass ( Fig. 1 B, arrow) over the mitral anterior leaflet at an angle of 0° ( Fig. 1 B; Video 1 B), the mass was not visualized at an angle of 108° ( Fig. 1 A; Video 1 A). When a mobile mass is seen close to the cardiac valve, it is essential to clarify its anatomical location. Three-dimensional (3D) TEE allowed us to visualize the full extent of the mobile mass, which originated from the aortic root abscess and extended towards the anterior mitral leaflet (AML) ( Fig. 2 ; Video 2 ) . Considering the patient’s recent history of recurrent cerebral haematoma 3 times, surgical treatment with cardiopulmonary bypass was contraindicated. Twenty days later, after strictly controlled antibiotic therapy, 3D TEE revealed that the mobile mass was no longer present. Our case has demonstrated that 3D TEE provides incremental information over 2D TEE for identifying the whole anatomy to evaluate an aortic root abscess.
