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

Medicine (Baltimore), 2016-10, Vol.95 (40), p.e5053 [Peer Reviewed Journal]

Copyright © 2016 the Author(s). Published by Wolters Kluwer Health, Inc. All rights reserved. 2016 ;ISSN: 0025-7974 ;EISSN: 1536-5964 ;DOI: 10.1097/MD.0000000000005053 ;PMID: 27749570

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  • Title:
    Nontraumatic avulsion of aortic valve commissure as a cause of acute aortic valve regurgitation: A case report
  • Author: Chang, Rei-Yeuh ; Chen, Chien-Chang ; Hsu, Wei-Pang ; Hsiao, Pei-Ching ; Tsai, Han-Lin ; Hsiao, Ping-Gune ; Wu, Jiann-Der ; Guo, How-Ran
  • Subjects: Acute Disease ; Aged, 80 and over ; Aortic Valve - diagnostic imaging ; Aortic Valve - surgery ; Aortic Valve Insufficiency - diagnosis ; Aortic Valve Insufficiency - etiology ; Aortic Valve Insufficiency - surgery ; Clinical Case Report ; Echocardiography ; Heart Valve Prosthesis ; Humans ; Male ; Severity of Illness Index
  • Is Part Of: Medicine (Baltimore), 2016-10, Vol.95 (40), p.e5053
  • Description: 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. 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. 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.
  • Publisher: United States: Wolters Kluwer Health
  • Language: English
  • Identifier: ISSN: 0025-7974
    EISSN: 1536-5964
    DOI: 10.1097/MD.0000000000005053
    PMID: 27749570
  • Source: IngentaConnect Free/Open Access Journals
    Journals@Ovid Open Access Journal Collection Rolling
    Wolters Kluwer Open Health
    MEDLINE
    PubMed Central
    DOAJ Directory of Open Access Journals
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