PMC10225878_01
(A-E): Echocardiography in transthoracic 3 chambers view (A) and transesophageal long axis view (B) demonstrating a 3.6 cm long vegetation protruding into the left ventricular outflow tract during diastole. TEE showed a moderate aortic regurgitation (C). Transthoracic echocardiographic clip with 3 chamber view of the infected aortic valve (D). Transesophageal echocardiographic clip presenting a long axis view of the infected aortic valve (E).
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Transthoracic and transesophageal echocardiography were performed and showed a sclerotic aortic valve with moderate aortic regurgitation, a flapping 3.6 cm vegetation on the right aortic cusp, as well as other smaller vegetations on the other cusps (Fig. 1).
A; Picture of excised valve in the operating theater with involvement of all three cusps. B; Macroscopic image of the excised aortic valve after formalin fixation showing dimensions of the largest vegetation on the right aortic cusp (scale bar in centimeters).
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Intraoperatively, the native aortic valve cusps showed marked destruction with vegetations of all three cusps with the largest vegetation measuring approximately 4 cm originating from the right coronary cusp (Fig. 2). Macro- and microscopic images are seen in Fig. 2, Fig. 3.