Infective bicuspid aortic valve endocarditis causing acute severe regurgitation and heart failure: A case report

Figure 1 Chest X-ray and computed tomography images. A: Chest X-ray upon presentation showed diffuse pulmonary edema and bilateral pleural effusion; B and C: Extensive pulmonary edema and bilateral pleural effusion were also observed on computed tomography scanning; D: Chest X-ray showed significant amelioration of pulmonary edema and pleural effusion following replacement of the infected valve.

Figure 2 Transthoracic and transesophageal echocardiography images. A: Immediate transthoracic echocardiography revealed severe aortic regurgitation without left ventricular enlargement; B: Transesophageal echocardiography also revealed severe aortic regurgitation; C: Vegetations attached to the bicuspid aortic valve were clearly visible; D: Postoperative transthoracic echocardiography revealed that regurgitation of the aortic prosthetic valve was significantly reduced.

Figure 3 Histopathology of valvular specimens and micro-organism culture of excised tissues. A: Histopathological examination demonstrated inflammatory infiltrates containing large numbers of neutrophils (Hematoxylin & eosin staining, × 40); B: Active inflammation with abundant neutrophilic infiltration could also be seen at high power view (Hematoxylin & eosin staining, × 200); C: Positive culture of Streptococcus sanguinis isolated from the resected samples; D: Microscopic appearance of cultured Streptococcus sanguinis.