Perivalvular Abscess Causing Coronary-Artery Compression

   This image-based case report describes a 67-year-old woman who presented with fatigue and anorexia three years after transcatheter aortic-valve replacement. Examination revealed hypotension, a systolic ejection murmur, and first-degree atrioventricular block. Lab testing showed elevated BNP (4631 pg/mL) and peak troponin (1.36 ng/mL). Echocardiography revealed reduced left ventricular ejection fraction (23%) and a thickened bioprosthetic valve with a mean gradient of 42 mm Hg. Blood cultures grew Streptococcus mutans. On the third hospital day, she developed shock and ventricular tachycardia. Coronary angiography showed severe narrowing of the left main and left circumflex coronary arteries. Intravascular ultrasonography and transesophageal echocardiography identified a large perivalvular aortic root abscess causing extrinsic coronary compression, including visible guidewire deformation. Despite bridging efforts, the patient died on hospital day four. 

   This image-based case report describes a 67-year-old woman who presented with fatigue and anorexia three years after transcatheter aortic-valve replacement. Examination revealed hypotension, a systolic ejection murmur, and first-degree atrioventricular block. Lab testing showed elevated BNP (4631 pg/mL) and peak troponin (1.36 ng/mL). Echocardiography revealed reduced left ventricular ejection fraction (23%) and a thickened bioprosthetic valve with a mean gradient of 42 mm Hg. Blood cultures grew Streptococcus mutans. On the third hospital day, she developed shock and ventricular tachycardia. Coronary angiography showed severe narrowing of the left main and left circumflex coronary arteries. Intravascular ultrasonography and transesophageal echocardiography identified a large perivalvular aortic root abscess causing extrinsic coronary compression, including visible guidewire deformation. Despite bridging efforts, the patient died on hospital day four.