Nontraumatic avulsion of aortic valve commissure as a cause of acute aortic valve regurgitation: A case report.

Abstract:

BACKGROUND:Avulsion of the aortic valve commissure as a cause of acute aortic valve regurgitation is mostly due to trauma, infective endocarditis, or ascending aortic dissection. Nontraumatic avulsion of the aortic valve commissure is very rare. We reviewed the literature and analyzed potential risk factors of nontraumatic avulsion. CASE PRESENTATION:An 80-year-old male with hypertension was seen in the emergency department with acute onset dyspnea. Echocardiogram revealed left ventricular hypertrophy with adequate systolic function, prolapse of the noncoronary cusp, and incomplete coaptation of the right coronary and noncoronary cusps with severe aortic valve regurgitation. Surgery revealed an avulsion between the left coronary and noncoronary cusps. Histopathology examination of the aortic valve showed myxoid degeneration, fibrosis, and calcification. Examination of the ascending aorta revealed myxoid degeneration and fragmentation of elastic fibers. Aortic valve replacement was performed, and the patient was alive and well 4 years after surgery. A review of the literature showed that more than three-fourths of the similar cases occurred in males, and about half in patients with hypertension and those 60 years of age or older. CONCLUSIONS:In the case of acute aortic regurgitation without a history of trauma, infection, or valvotomy, when 2 prolapsed aortic cusps are observed by echocardiography in the absence of an intimal tear of the ascending aorta, an avulsion of the aortic commissure should be suspected, especially in males with hypertension who are 60 years of age or older.

journal_name

Medicine (Baltimore)

journal_title

Medicine

authors

Chang RY,Chen CC,Hsu WP,Hsiao PC,Tsai HL,Hsiao PG,Wu JD,Guo HR

doi

10.1097/MD.0000000000005053

subject

Has Abstract

pub_date

2016-10-01 00:00:00

pages

e5053

issue

40

eissn

0025-7974

issn

1536-5964

pii

00005792-201610040-00052

journal_volume

95

pub_type

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