Staphylococcus aureus aortic valve endocarditis and its complications in a patient were readily recognized by echocardiography. "Shaggy" echoes recorded from the aortic leaflets in diastole as well as irregular diastolic densities in the left ventricular outflow tract suggested flail aortic leaflets secondary to bacterial endocarditis. The presence of a double echo of the anterior aortic wall was an unusual finding. Initially thought to represent a localized dissection, abscess formation and pocket of edematous fluid accumulation was found between the anterior aortic wall and pulmonary artery. Premature closure of the mitral valve was evident shortly before the patient died.
The specific echocardiographic features of flail aortic leaflets and premature mitral valve closure should alert the physician to consider immediate aortic valve replacement.
(Arch Intern Med 137:85-89, 1977)