Abstract
BACKGROUND: Complete avulsion accompanied by aortic root pseudoaneurysm is a rare complication of infective endocarditis (IE). Transesophageal echocardiography (TEE) plays an important role in perioperative evaluation. CASE PRESENTATION: A 38-year-old male patient, who underwent a Bentall procedure for an aortic aneurysm 8 years ago, was admitted with avulsion of a prosthetic aortic valve caused by IE. This led to significant structural damage and the development of an aortic root pseudoaneurysm. TEE provided real-time, multidimensional insights into IE-induced changes in adjacent structures and allowed detailed assessment of the composite graft’s integrity. A combined Bentall-Cabrol procedure was successfully performed, guided precisely by TEE findings. This included management of the floating prosthetic aortic valve and reconstruction of the aortic annulus. CONCLUSION: This case highlights the valuable role of TEE in diagnosing and guiding complex surgical interventions for IE, particularly when involving prosthetic valve complications. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13019-025-03758-3.