Rapid progression of aortic wall vegetation.

The patient was a 28-year-old man referred to our center because of presence of a cardiac murmur and persistence of fever for 3 weeks. A harsh, loud systolic murmur in the left sternal border without radiation to the neck and an early diastolic murmur in the right second intercostal space could be heard. Transesophageal echocardiography revealed a subaortic web with moderate to severe aortic regurgitation and a large vegetation on the sinotubular junction of the aorta. Repetitive echocardiography showed the progression of the infective process to abscess and finally saccular aneurysm formation. The fibrous web was excised; the incompetent aortic valve and the inflamed aortic wall were replaced. To the best of our knowledge, this is the first report of a large vegetation in the ascending aorta at the site of a turbulent jet caused by an untreated subaortic web detected with transesophageal echocardiography. Our case illustrates the value of repetition of this technique in the diagnosis of complications of vegetation especially when situated in unusual sites.