Symptomatic Aortic Stenosis
A 72-year-old man underwent aortic valve replacement 2 months ago for symptomatic severe aortic stenosis. He now presents with a 2-week history of fever, chills, rigors, and worsening fatigue. On physical exam, his blood pressure is 110/75 mm Hg, and pulse is 105 beats per minute and regular. Neck veins are flat, carotid pulses are normal, and lungs are clear to auscultation. Cardiac exam reveals a well-healed midline scar, a normal S1 and S2 with no S3 or S4 gallops. There is a 2/6 systolic ejection murmur in the left upper sternal border that radiates to the carotids. Extremities are warm with no peripheral edema.
 Figure 68-1. Transthoracic echocardiogram (TTE): Parasternal long-axis zoom. |
 Figure 68-2. 3D TTE: Parasternal short axis. |
A. Mitral ring abscess
B. Aortic root abscess
C. Aortic valve dehiscence
D. Gerbode defect
E. All of the options
View Answer
ANSWER 1: B. The echocardiogram demonstrates a bioprosthetic valve in the aortic position. There is evidence of abnormal thickening around the aortic ring in the parasternal long-axis and short-axis views (Figs. 68-2 and 68-3 and Videos 68-3 and 68-4, marked with arrows). These findings, coupled with the clinical history, suggest the presence of an aortic ring abscess. Some degree of thickening around a bioprosthetic valve may represent normal postoperative change, so it is helpful to obtain a baseline TTE after aortic valve replacement to serve as a baseline for serial comparison.
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