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Manifestation of Aortic Root Abscess From Acute Bacterial Endocarditis

      A 71-YEAR-OLD man with a history of coronary artery disease, moderate aortic stenosis, and arterial hypertension was scheduled for aortic valve replacement and possible aortic root replacement. One month before admission, he was treated for methicillin-sensitive Staphylococcus aureus endocarditis. A transthoracic echocardiogram revealed a lesion on the mitral valve that was suspected to be a vegetation associated with mild mitral regurgitation. The patient began a course of intravenous oxacillin as an outpatient. Two weeks later, the patient was admitted to the hospital with signs of worsening acute congestive heart failure. At that time, a transesophageal echocardiogram (TEE) was reported to show a mobile density on the mitral valve, a flail posterior mitral leaflet, and severe mitral regurgitation. A small fluid collection was noted in the posterolateral wall of the aortic root. After optimization, the patient was brought to the operating room for mitral valve and aortic valve replacement surgery.

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