Bioprosthetic valve degeneration on transesophageal echocardiogram (long axis)

Typical appearance of bioprosthetic degeneration on echocardiography. In this patient, aortic prosthetic mean gradient increased to 37 mmHg at 4 years after surgical implantation. The transesophageal echocardiographic long-axis view shows the echo-bright, immobile posterior cusp. The anterior cusp is mobile and thin. Signal intensity in the affected cusps is similar to the one in the prosthetic struts and higher than the unaffected cusp or soft tissues.