Multimodality imaging of mitral perivalvular abscess with annular fistula and preserved leaflet function.

A devastating complication of both native and prosthetic valvular infective endocarditis can involve periannular extension, which is associated with increased perioperative mortality and long-term adverse outcomes. Cardiac imaging, both noninvasive and invasive, is essential to accurately identify the extent and complexity of these infections to perform effective surgical interventional strategies. We present the case of a 62-year-old woman who was found to have a perivalvular mitral valve abscess with an annular fistula without evidence of mitral valve leaflet involvement on histopathology, diagnosed by 3-dimensional transesophageal echocardiography, computed tomography, and left ventriculography.