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An 87-year-old woman presented with acute fever of 38.3 C and rigors, who had undergone transcatheter aortic valve implantation (TAVI) with a 23-mm SAPIEN XT valve (Edwards Lifesciences, Irvine, CA, USA) for symptomatic severe aortic stenosis 2 years before and had no history of previous bacteraemia. Serial blood cultures were positive with Streptococcus agalactiae, though there were no signs of focal infection including intestinal or gynaecological. Diffusion-weighted magnetic resonance imaging detected acute asymptomatic stroke. Transthoracic echocardiography did not show vegetation or transcatheter heart valve (THV) dysfunction. Transoesophageal echocardiography (TOE) found thickened tip of one THV leaflet corresponding to right coronary cusp (Figure 1, left) without reduced leaflet motion (RLM). Multislice computed tomography (MSCT) detected 3.5-mm hypoattenuated leaflet thickening (HALT) at the same site (Figure 2, left).

european heart journal. case reports

Transcatheter aortic valve implantation associated prosthetic valve endocarditis with hypo-attenuated leaflet thickening seen on multislice computed tomography