She had a history of treated methicillin-resistant staphylococcus aureus bacteremia and endocarditis with involvement of the tricuspid valve. On admission, a cardiac computerized tomography angiogram (CTA) failed to demonstrate an aortic root abscess. However, an SVA was seen arising from the inferior right aortic cusp measuring 2.1 x 1.5 cm that descended along the intraventricular septum without communication to the right ventricle. The coronary anatomy was usual and all cardiac chambers were of normal size and thickness. Transthoracic echocardiogram revealed an echo-lucent space anterior to the aortic valve and aortic root, suggestive of a paravalvular abscess, with regurgitant flow into the LVOT and possibly into the lower right atrium (RA) (Fig. 3). The patient’s preoperative LV EF was
She had a history of treated methicillin-resistant staphylococcus aureus bacteremia and endocarditis with involvement of the tricuspid valve. On admission, a cardiac computerized tomography angiogram (CTA) failed to demonstrate an aortic root abscess. However, an SVA was seen arising from the inferior right aortic cusp measuring 2.1 x 1.5 cm that descended along the intraventricular septum without communication to the right ventricle. The coronary anatomy was usual and all cardiac chambers were of normal size and thickness. Transthoracic echocardiogram revealed an echo-lucent space anterior to the aortic valve and aortic root, suggestive of a paravalvular abscess, with regurgitant flow into the LVOT and possibly into the lower right atrium (RA) (Fig. 3). The patient’s preoperative LV EF was