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ditis. Electrocardiogram revealed sinus tachycardia and inferolateral ST segment depressions (Fig. 1a). Because the arterial blood gas analysis and chest X-ray (Fig. 1b) showed respiratory asidosis and pulmonary expansive volume load, respectively, the patient was entubated. An emergency transthoracic echocardiogram revealed a heart rate-dependent pendular “rocking motion” of the aortic valve prosthesis, consistent with dehiscence. The aortic valve was moving to the aorta in systole, whereas it was prolapsing to the left ventricle in diastole, resulting in severe paravalvular jet of aortic insufficiency (Fig. 2, Videos 1 and 2). Transesophageal echocardiography showed no vegetations on the mitral valve, but aortic valve was difficult to assess due to acoustic shadowing and artifacts. The systolic–diastolic ‘‘rocking motion’’ of the prosthesis was also clearly demonstrated by fluoroscopy (Fig. 3, Videos 3 and 4). E-page Original Images

Extreme mechanical aortic valve dehiscence: “rocking motion” clearly assessed with echocardiography and flouroscopy