A 36‑year‑old
male patient presented with the complaints of palpitations and
breathlessness. Preoperative
transthoracic echocardiography (TTE) revealed a
bicuspid aortic valve; severe
aortic regurgitation with dilated
left ventricle (LV) and mild
LV systolic dysfunction (ejection fraction 50%). He was scheduled to undergo
aortic valve replacement.
History was not suggestive of
infective endocarditis (IE). Preoperative TTE did not demonstrate any aortic perivalvular
abscess. Intraoperative
transesophageal echocardiography (TEE) examination using the mid‑esophageal (ME) long‑axis view, showed an
abscess cavity affecting the
aortic valve, which initially was assumed to be a
dissection flap, but later confirmed to be an
abscess cavity by
color Doppler examination. The ME
aortic valve short‑axis view showed two
abscesses; one was at the junction of the non‑coronary and left coronary commissure and the other one above the right coronary cusp. Intraoperatively, these findings were confirmed by the
surgeons. The case
report demonstrates the superiority of TEE over TTE in diagnosing perivalvular
abscesses.