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Isolated perforation of left coronary cusp after blunt chest trauma.

Maini R, Dadu RT, Addison D, Cunningham L, Hamzeh I, Wall M, Lakkis N, Tabbaa R - Case Rep Cardiol (2015)

Bottom Line: In the operating room he was found to have a left coronary cusp tear near the annulus and an enlarged right cusp.The patient recovered well after successful aortic valve replacement with a mechanical valve.Traumatic aortic regurgitation with left cusp perforation is serious and surgical intervention may be lifesaving if performed timely.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Baylor College of Medicine, USA.

ABSTRACT
Left coronary cusp perforation is an extremely rare consequence of blunt chest trauma. A 22-year-old male presented after a motor vehicle accident with dyspnea. Transthoracic echocardiogram (TTE) and transesophageal echocardiogram (TEE) showed moderate to severe aortic regurgitation with prolapsing right coronary cusp. In the operating room he was found to have a left coronary cusp tear near the annulus and an enlarged right cusp. The patient recovered well after successful aortic valve replacement with a mechanical valve. Traumatic aortic regurgitation with left cusp perforation is serious and surgical intervention may be lifesaving if performed timely.

No MeSH data available.


Related in: MedlinePlus

(a) TEE with color Doppler showing moderate to severe aortic regurgitation. (b) 3D by TEE showing prolapsed right coronary cusp. (c) Intraoperative image showing perforation of the left coronary cusp. (d) Pathologic specimen showing the three cusps.
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fig1: (a) TEE with color Doppler showing moderate to severe aortic regurgitation. (b) 3D by TEE showing prolapsed right coronary cusp. (c) Intraoperative image showing perforation of the left coronary cusp. (d) Pathologic specimen showing the three cusps.

Mentions: A 22-year-old male presented to the emergency room following a motor vehicle accident with an open right ankle, evidence of a femoral fracture, and shortness of breath. His past medical history was not significant for any medical conditions. He denied any drug abuse or smoking as well as any family history of heart disease. On initial exam, he was awake and afebrile; his blood pressure was 124/68 mm Hg and heart rate was 140 beats per minute, with an O2 saturation 100% on room air. Cardiovascular exam was notable for abnormal vital signs with a diastolic click heard best at the right second intercostal space. Cardiology was consulted on hospital day 6 due to runs of asymptomatic supraventricular tachycardia. Following the appreciation of a diastolic murmur, a TTE was performed showing moderate to severe aortic regurgitation by color Doppler (Figure 1) with a borderline normal left ventricular end-diastolic diameter concerning acute aortic regurgitation. A TEE was then performed to further delineate the aortic valve pathology, revealing an eccentric severe aortic regurgitation jet directed toward the anterior mitral valve leaflet (Figure 1) along with a prolapsing right coronary cusp concerning traumatic avulsion. The hospital course was then complicated by development of Clostridium difficile colitis for which patient received treatment. Following this, on hospital day 23 the patient underwent open heart surgery where he was found to have a tricuspid aortic valve with a left coronary cusp tear near the annulus as well as an enlarged prolapsing right coronary cusp. The valve was replaced with a 21 mm mechanical St. Jude Regent valve. Pathology revealed myxoid degeneration of the aortic valve leaflets without evidence of prior endocarditis or calcifications. The patient recovered without sequelae and is doing well at 2-month follow-up.


Isolated perforation of left coronary cusp after blunt chest trauma.

Maini R, Dadu RT, Addison D, Cunningham L, Hamzeh I, Wall M, Lakkis N, Tabbaa R - Case Rep Cardiol (2015)

(a) TEE with color Doppler showing moderate to severe aortic regurgitation. (b) 3D by TEE showing prolapsed right coronary cusp. (c) Intraoperative image showing perforation of the left coronary cusp. (d) Pathologic specimen showing the three cusps.
© Copyright Policy - open-access
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4352746&req=5

fig1: (a) TEE with color Doppler showing moderate to severe aortic regurgitation. (b) 3D by TEE showing prolapsed right coronary cusp. (c) Intraoperative image showing perforation of the left coronary cusp. (d) Pathologic specimen showing the three cusps.
Mentions: A 22-year-old male presented to the emergency room following a motor vehicle accident with an open right ankle, evidence of a femoral fracture, and shortness of breath. His past medical history was not significant for any medical conditions. He denied any drug abuse or smoking as well as any family history of heart disease. On initial exam, he was awake and afebrile; his blood pressure was 124/68 mm Hg and heart rate was 140 beats per minute, with an O2 saturation 100% on room air. Cardiovascular exam was notable for abnormal vital signs with a diastolic click heard best at the right second intercostal space. Cardiology was consulted on hospital day 6 due to runs of asymptomatic supraventricular tachycardia. Following the appreciation of a diastolic murmur, a TTE was performed showing moderate to severe aortic regurgitation by color Doppler (Figure 1) with a borderline normal left ventricular end-diastolic diameter concerning acute aortic regurgitation. A TEE was then performed to further delineate the aortic valve pathology, revealing an eccentric severe aortic regurgitation jet directed toward the anterior mitral valve leaflet (Figure 1) along with a prolapsing right coronary cusp concerning traumatic avulsion. The hospital course was then complicated by development of Clostridium difficile colitis for which patient received treatment. Following this, on hospital day 23 the patient underwent open heart surgery where he was found to have a tricuspid aortic valve with a left coronary cusp tear near the annulus as well as an enlarged prolapsing right coronary cusp. The valve was replaced with a 21 mm mechanical St. Jude Regent valve. Pathology revealed myxoid degeneration of the aortic valve leaflets without evidence of prior endocarditis or calcifications. The patient recovered without sequelae and is doing well at 2-month follow-up.

Bottom Line: In the operating room he was found to have a left coronary cusp tear near the annulus and an enlarged right cusp.The patient recovered well after successful aortic valve replacement with a mechanical valve.Traumatic aortic regurgitation with left cusp perforation is serious and surgical intervention may be lifesaving if performed timely.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Baylor College of Medicine, USA.

ABSTRACT
Left coronary cusp perforation is an extremely rare consequence of blunt chest trauma. A 22-year-old male presented after a motor vehicle accident with dyspnea. Transthoracic echocardiogram (TTE) and transesophageal echocardiogram (TEE) showed moderate to severe aortic regurgitation with prolapsing right coronary cusp. In the operating room he was found to have a left coronary cusp tear near the annulus and an enlarged right cusp. The patient recovered well after successful aortic valve replacement with a mechanical valve. Traumatic aortic regurgitation with left cusp perforation is serious and surgical intervention may be lifesaving if performed timely.

No MeSH data available.


Related in: MedlinePlus