Demonstration of Prosthetic Aortic Valve Dehiscence in a Patient With Noninfectious Aortitis by Multimodality Imaging

A 43-year-old man who had undergone aortic valve replacement (St. Jude Medical) for aortic regurgitation 9 years ago, presented to the emergency department with a sudden onset of chest pain. He began to have intermittent squeezing chest pain when he tried to lift a heavy object 2 weeks ago. When he arrived at our hospital, he reported chest pain persisting for >30 minutes. Electrocardiography and laboratory evaluation showed no evidence of myocardial ischemia (Figure 1). On physical examination, body temperature of 36.0°C, blood pressure of 167/77 mm Hg, and a holodiastolic murmur were noted. Peripheral stigmata of endocarditis were not found. He had no history of night sweats and weight loss. C-reactive protein was 0.14 mg/dL (normal range, <0.6 mg/dL), and the white blood cell count was 6100/μL. Blood culture was negative. Transthoracic echocardiography revealed the rocking motion (Movie I in the online-only Data Supplement) of the prosthetic aortic valve and severe paravalvular leakage (Figure 2; Movies II and III in the online-only Data Supplement). The pressure half-time of paravalvular regurgitation was 193 ms. Holodiastolic flow reversal in the descending thoracic aorta suggesting severe regurgitation was also found. On transesophageal echocardiography, the location of the paravalvular leakage was the …