An aortic annular abscess (aortic root abscess) can occur as a complication of aortic valve endocarditis and is more common on a prosthetic aortic valve. This is diagnosed predominantly on transesophageal echocardiography. The ECG can show an increasing PR interval consistent with first degree AV block or even high degree of AV block as the AV node is commonly involved. Prosthetic valve dehiscence may occur. Surgical debridement and replacement of the aortic root is the only therapeutic option.