Diagnosis and Management of Acute Aortic Valvular Disruption Secondary to Rapid-Deceleration Trauma

Abstract

Acute aortic valve rupture with resultant aortic insufficiency is a rare complication of blunt trauma. We describe a case in which a patient fell 70 feet, sustaining avulsion of two leaflets of the aortic valve along with multiple other injuries, primarily orthopedic. Our case demonstrates that patients with acute aortic regurgitation can be managed nonoperatively if necessary in the acute setting, enabling management of other significant trauma. Subsequent semielective valvular replacement may be undertaken if other injuries must take precedence.

Acute aortic valve insufficiency following blunt chest trauma

“…Among these cardiothoracic injuries, myocardial contusion is the most common lesion and is probably underdiagnosed [1][2][3]. Acute aortic valve insufficiency resulting from aortic valve perforation after blunt chest trauma is a rather rare combination [1][2][3][4][5]. The aortic valve is the most commonly injured valve after blunt chest trauma, followed by the mitral valve and the tricuspid valve [2][3][4].…”

“…Some patients present with acute and severe deterioration of cardiac function that requires immediate surgery, whereas others do not show symptoms until many years after the trauma. However, physicians must be aware of the possibility of rapid debasement even in the asymptomatic patient [2][3][4][5]. Some authors have remarked that cardiac catheterization is the gold standard for diagnosing traumatic AR [1,5].…”

“…However, physicians must be aware of the possibility of rapid debasement even in the asymptomatic patient [2][3][4][5]. Some authors have remarked that cardiac catheterization is the gold standard for diagnosing traumatic AR [1,5]. However, many authors agreed that transthoracic or transesophageal echocardiography is the test of choice, especially in the condition of severe trauma [1][2][3][4][5].…”

“…Moreover, most of these traumatic cardiac lesions are myocardial contusions [3]. However, profound aortic valve insufficiency owing to valve cusp involvement after blunt chest trauma is less common [1][2][3][4][5].…”

The surgical treatment of traumatic rupture of aortic valve and atrial septum after blunt chest trauma: literature review and presentation of a rare case

“…This region is responsible for the greatest incidence of ruptures (15 to 20%) and deaths in victims of car accidents [7]. Aortic failure is rarer in an analysis of publications and works performed in autopsies, and it is believed that it occurs due to the sudden increase of intrathoracic pressure during diastole, when the pressure gradient through the valve is at its maximum, and the valve is closed [8].…”