An unusual avulsion of the prosthetic aortic valve with an aortic root pseudoaneurysm: a case report

Complete avulsion accompanied by aortic root pseudoaneurysm is a rare complication of infective endocarditis (IE). Transesophageal echocardiography (TEE) plays an important role in perioperative evaluation. A 38-year-old male patient, who underwent a Bentall procedure for an aortic aneurysm 8 years ago, was admitted with avulsion of a prosthetic aortic valve caused by IE. This led to significant structural damage and the development of an aortic root pseudoaneurysm. TEE provided real-time, multidimensional insights into IE-induced changes in adjacent structures and allowed detailed assessment of the composite graft’s integrity. A combined Bentall-Cabrol procedure was successfully performed, guided precisely by TEE findings. This included management of the floating prosthetic aortic valve and reconstruction of the aortic annulus. This case highlights the valuable role of TEE in diagnosing and guiding complex surgical interventions for IE, particularly when involving prosthetic valve complications.