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Clinical Imaging

Beware of a New Heart Block: A Marker for Aortic Root Abscess

Luigi Pacifico, DO

Pradnya Brijmohan Bhattad, MD

June 2023

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A large vegetation extended from the aortic root into the left atrium with associated moderate to severe MR.

Bhattad Aortic Root Abscess Figure 1 — Figure 1. Electrocardiogram (ECG) showing sinus rhythm with a first degree atrioventricular (AV) block, Mobitz I second degree AV block with subtle ST segment depression in anterior leads. This is an ECG from a patient with aortic root abscess.

Bhattad Aortic Root Abscess Figure 2 — Figure 2. Baseline ECG in the same patient several months earlier, before any evidence of valvular abscess, showing normal sinus rhythm.

Bhattad Aortic Root Abscess Figure 3-6 — Figures 3-8 are transesophageal echocardiogram images showing an aortic root abscess with significant perivalvular bio-prosthetic aortic leak. A large vegetation extending from the aortic root into the left atrium measuring 1.32 cm x 2.66 cm with associated moderate to severe mitral regurgitation (MR) is visualized. The patient had a 23 mm Carpentier-Edwards bio-prosthetic aortic valve (Edwards Lifesciences) with a 1.3 cm perivalvular leak.

Bhattad Aortic Root Abscess Figure 7 — Figure 7. Perivalvular leak of aortic valve.

Bhattad Aortic Root Abscess Figure 8 — Figure 8. Perivalvular leak aortic valve and mitral valve regurgitation.

Disclosures: The authors report no conflict of interest regarding the content herein.

The authors can be contacted via Pradnya Brijmohan Bhattad, MD, at pradnyabhattad20@gmail.com.

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