Asymptomatic chronic traumatic aortic valve perforation with severe aortic regurgitation

Abstract

Here, we present a young asymptomatic male patient incidentally diagnosed to have aortic regurgitation (AR). The patient had a history of a blunt trauma to the thorax two years back but did never have any symptoms. Transthoracic echocardiography showed a moderately dilated left ventricle with normal systolic function and severe AR with normal nondilated aortic root and tri‐leaflet aortic valve. To diagnose the etiology of the AR, a transesophageal echocardiogram (TEE) was done, which revealed a perforation in the nonadjacent leaflet (NAL) and confirmed severe AR with two AR jets being clearly visualized, one through the point of incomplete coaptation and other one through the perforated area in the NAL. The patient was treated with aortic valve replacement and was doing well on follow‐up.

Specific aortic regurgitation: rupture of Valsalva aneurysm causes aortic valve prolapse and spontaneous valve perforation; Concomitant ventricular septal defect

“…It may be accompanied by ventricular septal defect, aortic regurgitation [3] and so on. Aortic valve rupture and perforation is more common in infection, trauma, invasive operation [4][5] . It is rare to see spontaneous perforation of the valve itself resulting in aortic regurgitation.…”

Delayed Aortic Valve Perforation Caused by Blunt Trauma

“…This type of injury is typically sustained during horrific traffic accidents or a fall from a height [4]. The mechanism of injury is likely caused by a high transvalvular gradient resulting from increased pressure inside the aortic root against a closed aortic valve and low LV pressure in diastole [5]. The noncoronary cusp (NCC) is most frequently involved in AR due to blunt chest trauma, followed by the RCC [2,4].…”

“…The left coronary cusp (LCC) is rarely involved in blunt chest trauma-associated AR [2]. This may be due to two mechanisms: (1) the LCC is a more posterior structure that is less commonly involved in trauma, and (2) the origin of the coronary artery is situated on the LCC, which reduces the pressure sustained by the leaflet [5]. The diagnosis of traumatic AR is traditionally based on 4 criteria, including: (1) a history of blunt chest trauma; (2) absence of a history of heart disease; (3) sudden onset of signs and symptoms of AR; and (4) visualization of severe AR on cardiac imaging such as thoracic aortography or echocardiography [1].…”