Author : Dr. Andrea Perne.
Club 35 ambassador
Emergency transthoracic echocardiography showing an abnormal structure at the septal leaflet of the tricuspid anulus.
Different echocardiographic window confirming the suspicious structure at the tricuspid septal leaflet with proximity to the aortic root
A transesophageal echocardiogram was performed which showed prominent thickening of the aortic root suggestive of endocarditis which had protruded to the right atrium.
The aortic root and the suspicious structure in 3D transesophaegeal echocardiography.
Imaging with the 3D-transesophageal probe with x-plane imaging failing to demonstrate direct contact between the endocarditic structure and the tricuspid valve.
The patient was taken to the operating room where he got an aortic valve and root replacement as well as a reconstruction of the tricuspid and the mitral valve.
The postoperative course was fine until, after 6 days the patient became hemodynamically instable and had to be put on mechanical ventilation and catecholamines again.
A new transesophageal echocardiography was performed showing a big paraaortal cavity.
Transesophageal echocardiogram 9 days after the initial operation showing a large cavity in the aortic root. Differential diagnosis was a big abcess or a paraaortic hematoma.
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