PMC4469760_01
Vasculitic lesions. Multiple embolic lesions were present on the left fourth and fifth fingertips and left first toe.
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fig1
Electrocardiogram. Day 1 ECG on left and day 2 on right. Day 1 ECG reveals probable sinus tachycardia with first-degree heart block at 111 bpm. Day 2 ECG shows complete heart block with a ventricular rate of 67 bpm.
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fig2
Initial ECG showed probable sinus tachycardia with first-degree atrioventricular block (Figure 2). Overnight the patient was noted to have arrhythmias on telemetry and a repeat ECG showed new complete heart block (Figure 2).
Transesophageal echocardiogram. Mass seen on anterior leaflet measuring 1.2 x 1.8 cm with perforation of the leaflet. Bicuspid aortic valve with severe aortic regurgitation and abscess cavity and fistula extending from right coronary cusp to left atrium.
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fig3
Transesophageal echocardiogram (TEE) demonstrated a bicuspid aortic valve with multiple mobile echo densities along both the anterior and posterior leaflets with the largest one measuring 1.8 cm (Figure 3).