Is establishing diagnosis of perivalvular abscess still difficult

We report the case of 42-year-old male, who developed infective endocarditis on bicuspid aortic valve due to infection of the central line with Staphylococcus aureus MSSA. The patient was hospitalised several times in district hospitals because of worsening of heart failure. He had a few transthoracic (TTE) and one transesophageal (TEE) echocardiography which did not reveal early stages of perivalvular abscess and was disqualified from surgical procedures due to bad left ventricular systolic function. The second TEE done a month after the first one showed an abscess with perforation to the right ventricle. The patient died disqualified again from surgical procedure due to multiorgan failure.