An aortic valve tear associated with aortic regurgitation following blunt chest trauma is seldom seen. In this case, a 55-year-old man sustained a non-penetrating chest injury caused by a sudden fall from 10 meters. This led to a sizable tear in the left coronary cusp associated with severe aortic insufficiency. The case was treated successfully by surgical replacement of the aortic valve with a mechanical prosthesis

chen, Xin

Li, Weidong

Ma, Liang

Ni, Yiming

English

PubMed

Weidong Li

Yiming Ni

Xin chen

Liang Ma

Springer - Publisher Connector

Aortic valve tear with severe aortic regurgitation following blunt chest trauma

Abstract An aortic valve tear associated with aortic regurgitation following blunt chest trauma is seldom seen. In this case, a 55-year-old man sustained a non-penetrating chest injury caused by a sudden fall from 10 meters. This led to a sizable tear in the left coronary cusp associated with severe aortic insufficiency. The case was treated successfully by surgical replacement of the aortic valve with a mechanical prosthesis.</p

chen Xin

Ni Yiming

Li Weidong

Ma Liang

Directory of Open Access Journals

Journal of Cardiothoracic Surgery

CASE REPORT Open Access
Aortic valve tear with severe aortic regurgitation
following blunt chest trauma
Weidong Li, Yiming Ni, Xin chen and Liang Ma*
Abstract
An aortic valve tear associated with aortic regurgitation following blunt chest trauma is seldom seen. In this case, a
55-year-old man sustained a non-penetrating chest injury caused by a sudden fall from 10 meters. This led to a
sizable tear in the left coronary cusp associated with severe aortic insufficiency. The case was treated successfully
by surgical replacement of the aortic valve with a mechanical prosthesis.
Background
Aortic valve tear is a rare complication of blunt chest
trauma which can lead to severe aortic regurgitation.
Blunt chest traumas are frequently caused by traffic
accidents or falls from a great height. Here, we present
a case of a tear in the aortic valve associated with severe
aortic regurgitation following blunt chest trauma caused
by falling from a great height.
Case report
A 55-year-old man suffered from a sudden fall from 10
meters. He was immediately sent to a local hospital and
was diagnosed with multiple bone fractures including
pelvis, right acetabulum and right radius. He also com-
plained of shortness of breath and transthoracic echo-
cardiography (TTE) showed aortic valve prolapse
associated with moderate aortic regurgitation. Due to
the stable hemodynamic situation, conservative treat-
ment of the bone fractures was given first.
Four months later, he was transferred to our hospital
for further treatment of aortic prolapse. On physical
examination, the patient showed no acute distress. His
blood pressure was 135/65 mmHg and pulse rate was
81 beats per min. A grade 4/6 diastolic murmur and sig-
nificant thrill was heard in the aortic area. An electro-
cardiogram showed no abnormality. Chest X-ray did not
reveal pulmonary congestion and pulmonary inflamma-
tion. TTE revealed severe aortic regurgitation and the
prolapse of the left coronary cusp. These investigations
confirmed massive aortic regurgitation, which was
thought to be due to the rupture of the left coronary
cusp.
The patient underwent surgery. Following aortic
cross-clamping and cardioplegic arrest, the ascending
aorta was opened on total cardiopulmonary bypass. We
found a tear of about 10 mm in the left coronary cusp
which caused the prolapse of this cusp. No abnormal-
ities were found in the aortic wall and aortic valve annu-
lus. The aortic valve was removed and replaced with a
No. 21 Carbomedics mechanical prosthesis.
The post-operative period was uneventful and the
patient was discharged 10 days after operation. The
structure and function of the prosthetic aortic valve was
good as assessed by ultrasound cardiogram (UCG) dur-
ing the follow-up period and no aortic valve regurgita-
tion was found. The patient remains well more than 1
year after operation.
Discussion
Blunt chest trauma often occurs after high-speed traffic
accidents or after falls. The common injury is myocar-
dial contusion which presents with transitory shortness
of breath, increasing cardiac enzymes and mild abnorm-
ality of the electrocardiogram. The patient usually
recovers with conservational treatment.
But an aortic valve tear following blunt chest trauma
is very rare. Since Penderleath found the first case of
acute aortic valve tear in the biopsy of one traffic acci-
dent victim in 1830 [1], no more than 100 cases were
reported all over the world up to 2002 [2].
The mechanism causing aortic valve lesions is consid-
ered to be a sudden increase in intracardiac pressure
during a vulnerable phase of the cardiac cycle, especially
* Correspondence: zyxxml@hotmail.com
Department of Cardiothoracic Surgery, 1st Affiliated Hospital, School of
Medicine, Zhejiang University, Hang Zhou, 310003, China
Li et al. Journal of Cardiothoracic Surgery 2011, 6:84
http://www.cardiothoracicsurgery.org/content/6/1/84
© 2011 Li et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
during early diastole, when the transaortic gradient is
maximal [3]. This leads to a tear or rupture of the aortic
cusp. Usually only one is damaged, and the non-coron-
ary cusp is most commonly involved. In the reports
between 1994 and 2005, 28 aortic cusp lesions were
decribed. Fourteen were non-coronary, 10 right coron-
ary and only 4 left coronary [4]. The possible mechan-
ism is that the outflow into the right and left coronary
arteries may decrease the hemodynamic stress to the left
and right aortic valve cusps. Since the right coronary
cusp is closer to the anterior chest wall, it may suffer
higher pressure and be more likely to tear than the left
cusp. In the case presented here, the left coronary cusp
was torn, a very rare occurrence.
The diagnosis of traumatic aortic valve tear is not dif-
ficult: acute or progressive heart failure, a new heart
murmur and a history of blunt chest trauma. But it
often takes more than one week from the trauma to the
onset of heart failure. Furthermore, the existence of
multiple injuries may cover the chest symptoms. So
more attention should be paid to patients with blunt
chest trauma in clinical experience. UCG is very useful
in defining injury of the aortic valve and confirming the
presence of aortic regurgitation.
The decision to operate is very important and can be
decided on the basis of heart function and the systemic
situation. If the aortic regurgitation does not impair
hemodynamic stability, or if there are other lesions that
may increase operative risk, as in our case, delayed
instead of emergency operation is advised, as this allows
the surgeon to select the best conditions for interven-
tion. Since there may be an asymptomatic period for a
week or more, surgeons treating these patients should
be aware of the potential for rapid decompensation and
the need for an emergency operation.
The indications for the valve replacement or repair
depend on many factors: the extent of injury to the
cusp, the number of cusps or commissures involved,
and the ability of the surgeon to performance aortic
valve repair. Prosthetic valve replacement is preferred in
cases with a complicated tear or multiple lesions of the
cusp [4]. However, in some cases where the aortic root
or valve commissures are involved, replacement with a
composite mechanical valved-dacron graft conduit
should be considered [5]. Repair methods such as direct
suture or auto-pericardial patch are suitable for a simple
and regular rupture in one cusp [6]. But one type of
rupture of the cusp should receive special attention.
One report showed a visible tear of the non-coronary
cusp during operation without any lesions of the left
and right coronary cusps. While microscopic examina-
tion of the pathological tissue also revealed a tear in the
left cusp, which had suffered no laceration [7]. This
finding seems to indicate that it may not be possible to
diagnose the extent of a rupture by direct visual obser-
vation during surgery. In this case, repairing only the
non-coronary cusp may lead to an insufficiency of the
left coronary cusp in the future. So we think that even
in the lesion of a single valve cusp, if the rupture is
severe, the potential rupture of other cusps should be
considered and a prosthetic valve replacement is a good
and safe choice.
Consent
Written informed consent was obtained from the patient
for publication of this case report and accompanying
images. A copy of the written consent is available for
review by the Editor-in-Chief of this journal.
Figure 1 TTE from apical 5-chamber plane view showing
prolapse of the left coronary cusp (green arrow). AV: aortic
valve; LA: left atrium; LV: left ventricle; RA: right atrium; RV: right
ventricle.
Figure 2 A 10-mm tear in the left coronary cusp . LCC: left
coronary cusp; RCC: right coronary cusp; NCC: non coronary cusp.
Li et al. Journal of Cardiothoracic Surgery 2011, 6:84
http://www.cardiothoracicsurgery.org/content/6/1/84
Page 2 of 3
Authors’ contributions
WL wrote the draft of the manuscript and obtained the written consent. XC
performed the literature review and participated in the manuscript writing.
NM was the cardiology consultant. LM helped to the final writing of the
paper and gave final approval of the manuscript. All authors have read and
approved the final manuscript.
Competing interests
The authors declare that they have no competing interests.
Received: 15 March 2011 Accepted: 19 June 2011
Published: 19 June 2011
References
1. Penderleath D: Case of death from rupture of one of semilunar valves of
the aorta. London Medical Gazette 1830, 7:109.
2. Meunier JP, Berkane N, Lopez S, El Ghobary T, Teboul J, Malzac B, Isetta C,
Jourdan J: Traumatic aortic regurgitation: aortic valvuloplasty controlled
by aortoscopy. J Heart Valve Dis 2001, 10:784-788.
3. Banning AP, Pillai R: Non-penetrating cardiac and aortic trauma. Heart
1997, 78:226-229.
4. Turk T, Vural H, ATA Y, Eris C, Yavuz S: Acute aortic insufficiency after
blunt chest trauma: a case report. J Cardiovasc Surg 2007, 48:359-361.
5. Singhal P, ch M, Kejriwal N, FRACS: Ascending aortic tear with severe
aortic regurgitation following rugby injury. Heart, Lung and Circulation
2008, 1-2.
6. Asbach S, Siegenthaler MP, Beyersdorf F, Bode C, Geibel A: Aortic valve
rupture after blunt chest trauma. Clinical Research in Cardiology 2006,
95(12):675-679.
7. Egoh Y, Okoshi T, Anbe J, Akasaka T: Surgical treatment of traumatic
rupture of the normal aortic valve. Eur J Cardiothorac Surg 1997,
11:1180-1182.
doi:10.1186/1749-8090-6-84
Cite this article as: Li et al.: Aortic valve tear with severe aortic
regurgitation following blunt chest trauma. Journal of Cardiothoracic
Surgery 2011 6:84.
Submit your next manuscript to BioMed Central
and take full advantage of: 
• Convenient online submission
• Thorough peer review
• No space constraints or color figure charges
• Immediate publication on acceptance
• Inclusion in PubMed, CAS, Scopus and Google Scholar
• Research which is freely available for redistribution
Submit your manuscript at 
www.biomedcentral.com/submit
Li et al. Journal of Cardiothoracic Surgery 2011, 6:84
http://www.cardiothoracicsurgery.org/content/6/1/84
Page 3 of 3


A: Aortic valve rupture after blunt chest trauma. Clinical Research in Cardiology

Acute aortic insufficiency after blunt chest trauma: a case report. J Cardiovasc Surg

Case of death from rupture of one of semilunar valves of the aorta.

FRACS: Ascending aortic tear with severe aortic regurgitation following rugby injury. Heart, Lung and Circulation

Non-penetrating cardiac and aortic trauma. Heart

Surgical treatment of traumatic rupture of the normal aortic valve. Eur J Cardiothorac Surg

Traumatic aortic regurgitation: aortic valvuloplasty controlled by aortoscopy. J Heart Valve Dis

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3133542

Aortic valve tear with severe aortic regurgitation following blunt chest trauma

Abstract

Similar works

Full text

Available Versions

Springer - Publisher Connector

Directory of Open Access Journals

Springer - Publisher Connector