Aortic valve tear with severe aortic regurgitation following blunt chest trauma

Aortic valve tear is a rare complication of blunt chest trauma which can lead to severe aortic regurgitation. Blunt chest traumas are frequently caused by traffic accidents or falls from a great height. Here, we present a case of a tear in the aortic valve associated with severe aortic regurgitation following blunt chest trauma caused by falling from a great height.A 55-year-old man suffered from a sudden fall from 10 meters. He was immediately sent to a local hospital and was diagnosed with multiple bone fractures including pelvis, right acetabulum and right radius. He also complained of shortness of breath and transthoracic echocardiography (TTE) showed aortic valve prolapse associated with moderate aortic regurgitation. Due to the stable hemodynamic situation, conservative treatment of the bone fractures was given first.Four months later, he was transferred to our hospital for further treatment of aortic prolapse. On physical examination, the patient showed no acute distress. His blood pressure was 135/65 mmHg and pulse rate was 81 beats per min. A grade 4/6 diastolic murmur and significant thrill was heard in the aortic area. An electrocardiogram showed no abnormality. Chest X-ray did not reveal pulmonary congestion and pulmonary inflammation. TTE revealed severe aortic regurgitation and the prolapse of the left coronary cusp. These investigations confirmed massive aortic regurgitation, which was thought to be due to the rupture of the left coronary cusp.The patient underwent surgery. Following aortic cross-clamping and cardioplegic arrest, the ascending aorta was opened on total cardiopulmonary bypass. We found a tear of about 10 mm in the left coronary cusp which caused the prolapse of this cusp. No abnormalities were found in the aortic wall and aortic valve annulus. The aortic valve was removed and replaced with a No. 21 Carbomedics mechanical prosthesis.The post-operative period was uneventful and the patient was discharged 10 days after operation. The stru