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

Rei Yeuh Chang, Chien Chang Chen, Wei Pang Hsu, Pei Ching Hsiao, Han Lin Tsai, Ping Gune Hsiao, Jiann Der Wu, How-Ran Guo

Research output: Contribution to journalArticle

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.

Original languageEnglish
Article numbere5053
JournalMedicine (United States)
Volume95
Issue number40
DOIs
Publication statusPublished - 2016 Jan 1

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Aortic Valve Insufficiency
Aortic Valve
Hypertension
Aorta
Tunica Intima
Elastic Tissue
Prolapse
Wounds and Injuries
Left Ventricular Hypertrophy
Endocarditis
Dyspnea
Echocardiography
Dissection
Hospital Emergency Service
Fibrosis
Infection

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Chang, Rei Yeuh ; Chen, Chien Chang ; Hsu, Wei Pang ; Hsiao, Pei Ching ; Tsai, Han Lin ; Hsiao, Ping Gune ; Wu, Jiann Der ; Guo, How-Ran. / Nontraumatic avulsion of aortic valve commissure as a cause of acute aortic valve regurgitation A case report. In: Medicine (United States). 2016 ; Vol. 95, No. 40.
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Nontraumatic avulsion of aortic valve commissure as a cause of acute aortic valve regurgitation A case report. / Chang, Rei Yeuh; Chen, Chien Chang; Hsu, Wei Pang; Hsiao, Pei Ching; Tsai, Han Lin; Hsiao, Ping Gune; Wu, Jiann Der; Guo, How-Ran.

In: Medicine (United States), Vol. 95, No. 40, e5053, 01.01.2016.

Research output: Contribution to journalArticle

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T1 - Nontraumatic avulsion of aortic valve commissure as a cause of acute aortic valve regurgitation A case report

AU - Chang, Rei Yeuh

AU - Chen, Chien Chang

AU - Hsu, Wei Pang

AU - Hsiao, Pei Ching

AU - Tsai, Han Lin

AU - Hsiao, Ping Gune

AU - Wu, Jiann Der

AU - Guo, How-Ran

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N2 - 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.

AB - 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.

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