Baylor University Medical Center Proceedings July 2017 - 305

Aortic valve perforation secondary to blunt force trauma
Sachin Mehta, MD, Gibbs Wilson, MD, Keith Suarez, MD, and Christopher D. Chiles, MD

Blunt chest trauma has seldom
been reported as a cause of
rupture of an aortic valve cusp.
We report the case of a 63-yearold man who had a motor vehicle
collision resulting in transection
of the descending thoracic aorta,
splenic pseudoaneurysm, and
rupture of an aortic valve cusp
causing severe aortic regurgitation. Despite replacement of the
aortic valve, he died of multiorgan
failure.

a

b

Figure 1. (a) Continuous wave Doppler of the aortic valve and (b) pulsed wave Doppler of the descending thoracic aorta.
The measured pressure half time is 146 milliseconds with a dense Doppler signal, and there is holodiastolic flow reversal.
These findings are concerning for severe aortic regurgitation.

CASE DESCRIPTION
A 63-year-old hypertensive man was brought to the emergency room after a motor vehicle collision in which he was the
restrained driver of a vehicle struck on the passenger side. On
arrival his heart rate was 120 beats per minute and his systolic
blood pressure was 90 mm Hg. Precordial auscultation disclosed
no murmurs. Computed tomography of the chest with contrast
showed transection of the descending thoracic aorta and splenic
aneurysms. He underwent endovascular repair of the thoracic
aorta; due to persistent hypotension, he also underwent exploratory laparotomy, which had unremarkable findings. On return
to the intensive care unit, his blood pressure was 100/30 mm Hg.
Transthoracic echocardiogram revealed holodiastolic flow reversal in the aorta and a short pressure half time of 146 milliseconds (Figure 1). Transesophageal echocardiography excluded
aortic dissection and further demonstrated perforation of the
left and noncoronary cusps (Figure 2). Emergent aortic valve
replacement with a 25 mm Medtronic porcine bioprosthesis
was performed, but the patient died 48 hours following the
operation.
DISCUSSION
Traumatic aortic regurgitation is rare (1), with less than 100
cases dating to 2002 (2). It is believed that if blunt force chest
trauma occurs during ventricular diastole, the rise of intraaortic pressure against a closed aortic valve may cause rupture or
Proc (Bayl Univ Med Cent) 2017;30(3):305-306

Figure 2. Transesophageal echocardiography with long-axis view of the aortic
valve. Perforation of the noncoronary cusp can be appreciated with diastolic flow
traveling through it, as demonstrated with color Doppler.

From the Department of Internal Medicine (Mehta, Wilson) and the Department of
Cardiovascular Diseases (Suarez, Chiles), Baylor Scott & White Hospital, Temple,
Texas.
Corresponding author: Sachin Mehta, MD, 764 Marlandwood Road, Apt. 435,
Temple, TX 76502 (e-mail: Sachin.Mehta@BSWHealth.org).
305



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