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With this case,

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we're gonna review a patient who had a TAVR placed and then ended up getting

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a subsequent infection.

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This person unfortunately had a large vegetation,

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which we're gonna take a look at, so you can see the TAVR device in place.

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And then as we scroll in fairly into the device itself,

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you'll notice immediately that you have really thickened prosthetic valve

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leaflets.

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And then as we go more inferiorly and you see that there's this almost mass like

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thickening centrally.

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And then as you continue inferiorly more,

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actually now getting below the level of the leaflets themselves,

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but there's this more of almost like polypoid mass that's

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hanging off the leaflet itself down below the level of the leaflets into the

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left ventricular outflow tract. And that's pretty typical for a vegetation.

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And I just wanna show you that in the coronal images,

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I think it shows up really nicely here. This is the vegetation, uh,

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sitting in the middle of a valve for this particular patient.

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There's associated, like I said, leaflet, thickening everywhere.

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And this is a really extensive case of prosthetic valve

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infection. If you get cine images, then you can look at the motion

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and you would expect to see that the prosthetic valve motion is

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restricted because of all this leaflet thickening.

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And then usually you'll see that vegetation prolapsing in and out of the

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outflow tract throughout the cardiac cycling and see it kind of moves upward

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there and then moves downward.

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So this is a pretty classic case of valve infection. Fortunately,

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these things are quite rare, but when you do see it,

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it's definitely a emergency for the patient and um,

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it will certainly need some IV antibiotics as soon as possible.

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One other thing to point out in this patient,

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he was actually unlucky enough to also have infection of his mitral valve.

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So if you scroll across on these sagal images,

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you'll see that there's a lot of thickening and nodularity here

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along the anteriorly, the mitral valve as well.

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And so he had both infection of his prosthetic aortic valve and

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his native mitral valve.

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I can show that with the N P R as well. Here.

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I'm just gonna change my orientation parallel to the annulus of

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the mitral valve. And you can see here on this short axis image,

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there's all this mitral annular calcification.

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And then in addition to calcification,

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you have all this really nodular soft tissue.

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So this is all infected material within the mitral valve AMB in this patient.