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

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 ris...

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Autores principales: Chang, Rei-Yeuh, Chen, Chien-Chang, Hsu, Wei-Pang, Hsiao, Pei-Ching, Tsai, Han-Lin, Hsiao, Ping-Gune, Wu, Jiann-Der, Guo, How-Ran
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5059073/
https://www.ncbi.nlm.nih.gov/pubmed/27749570
http://dx.doi.org/10.1097/MD.0000000000005053
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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
author_facet Chang, Rei-Yeuh
Chen, Chien-Chang
Hsu, Wei-Pang
Hsiao, Pei-Ching
Tsai, Han-Lin
Hsiao, Ping-Gune
Wu, Jiann-Der
Guo, How-Ran
author_sort Chang, Rei-Yeuh
collection PubMed
description 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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spelling pubmed-50590732016-11-01 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 Medicine (Baltimore) 3400 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. Wolters Kluwer Health 2016-10-07 /pmc/articles/PMC5059073/ /pubmed/27749570 http://dx.doi.org/10.1097/MD.0000000000005053 Text en Copyright © 2016 the Author(s). Published by Wolters Kluwer Health, Inc. All rights reserved. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0
spellingShingle 3400
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
title Nontraumatic avulsion of aortic valve commissure as a cause of acute aortic valve regurgitation: A case report
title_full Nontraumatic avulsion of aortic valve commissure as a cause of acute aortic valve regurgitation: A case report
title_fullStr Nontraumatic avulsion of aortic valve commissure as a cause of acute aortic valve regurgitation: A case report
title_full_unstemmed Nontraumatic avulsion of aortic valve commissure as a cause of acute aortic valve regurgitation: A case report
title_short Nontraumatic avulsion of aortic valve commissure as a cause of acute aortic valve regurgitation: A case report
title_sort nontraumatic avulsion of aortic valve commissure as a cause of acute aortic valve regurgitation: a case report
topic 3400
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5059073/
https://www.ncbi.nlm.nih.gov/pubmed/27749570
http://dx.doi.org/10.1097/MD.0000000000005053
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