PMC8486556_01
(a, b) Transesophageal echocardiogram showing aortic valve endocarditis (AV) and associated aortic root thickness and abscess. View in (a): color Doppler, apical long axis. View in (b): short-axis.
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Due to poor images on a transthoracic echocardiography (TTE), a transesophageal echocardiography (TEE) and soft tissue chest CT scan was also performed which revealed a severely stenotic bicuspid aortic valve with fusion of the left and noncoronary cusps as well as an ascending aorta dilatation of 4.8 cm and aortic root dilatation of 4.5 cm with concern for an aortic root abscess (Figures 1(a), 1(b), and 2).
Transesophageal echocardiogram showing aortic sinus of Valsalva aneurysm extending posteriorly to interatrial septum (white arrow) and ventricular septal defect (yellow arrow). View: color Doppler, apical four chamber.
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Upon arrival back to the hospital, TEE revealed a normally seated bioprosthetic aortic valve with no abnormal valvular motion or apparent dysfunction but had a large ventral septal defect (VSD) involving the lower border of the valve which entered the right ventricle adjacent to the septal leaflet of the tricuspid valve (Figure 3).
Transesophageal echocardiogram showing aortopulmonary fistula. View: color Doppler, long axis view:upper esophageal. AO: ascending aorta; PA: pulmonary artery.
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It also showed an aortopulmonary artery fistula connecting the sinus of Valsalva to the pulmonary artery and moderate dilatation of the aortic root with an aneurysmal appearance (Figure 4).