Endocarditis associated pseudoaneurysm in intravenous drug abuser

A 34-year-old man with a history of intravenous drug abuse and chronic hepatitis C. Was admitted with Staphylococcus aureus bacteriaemia and aortic valve endocarditis and cerebral embolic phenomena and signs of neuroinfection. The echocardiographic examinations revealed aortic valve endocarditis with server aortic regurgitation and a large pseudoaneurysm. The patient was deemed inoperable by the endocarditis team and treated with antibiotics.

An initial transoesophageal echocardiogram (TOE) was performed, a parasternal long-axis view (PLAX) with increased depth (Panel A) revealed a large pseudoaneurysm. Examining the chordae attached to the mitral valve, you get the impression that they are very tight, restricting coaptation of the mitral valve, however no...