稀な損傷形態を呈した外傷性大動脈弁閉鎖不全の1症例

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  • An unusual case of traumatic aortic regurgitation

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We present a rare, nonpenetrating aortic valve injury after blunt chest trauma. A 53-year-old man on a bike collided with a truck and suffered bilateral hemopneumothrax, lung contusions and multiple rib fractures in the chest and many other traumas. Diastolic murmur was recognized with developing heart failure on the 18th day after the accident. An transthoracic echocardiography revealed severe aortic valve regurgitation without left ventricular dilatation and as infectious endocarditis was ruled out by transesophageal echocardiography, blood culture and chest CT, therefore we diagnosed it as a nonpenetrating aortic valve injury with acute onset regurgitation caused by blunt impact. Aortic valve was replaced on the 119th day. Inspection during the surgery made it apparent that the commissure between the non-coronary cusp leaflet and the left coronary cusp leaflet was detached from the aortic wall and neither tear nor avulsion existed in any one of the three cusp leaflets, which was comfirmed by histological examination. To our knowledge, aortic valve injury of this kind has never been reported.<br>The patient's postoperative course was uneventful and he discharged on the 140th day after the accident.

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