Echocardiographic abnormalities in acute rupture of the aortic valve due to infective endocarditis

The M-mode echocardiographic findings seen in 5 patients with acute rupture of the aortic valve leaflets due to infective endocarditis are described. These findings embrace a wide spectrum of abnormalities seen in the aortic root in diastole and they are (1) fine, high frequency oscillating echoes, (2) thick oscillating bands of echoes, and (3) dense shaggy echoes loosely attached to the aortic valve leaflets. Three patients showed persistence of these aortic root echoes right up to the level of the left ventricular outflow tract. All 5 patients demonstrated early closure of the mitral valve and exaggerated motion of the interventricular septum and the posterior wall of the left ventricle. Two patients died from the illness and the remaining 3 had successful aortic valve replacement after appropriate antibiotic therapy. The aortic valve and the aortic root were carefully examined in all 5 patients either at necropsy or at operation. Two patients had leaflet perforation alone, whereas the remaining 3 had both leaflet perforations as well as vegetations. An attempt was made to correlate morphologic findings with the echocardiographic abnormalities. It is concluded that it is frequently difficult from abnormal echoes in the aortic root alone to differentiate between ruptured leaflets and vegetations. However, the presence of the combination of early closure of the mitral valve, exaggerated motion of the interventricular septum and the posterior wall of the left ventricle, together with abnormal aortic root echoes as described above should strongly suggest acute rupture of the aortic valve leaflets due to infective endocarditis, or in rare cases myxomatous degeneration of the aortic valve.