Traumatic disruption of the aortic valve

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AORTIC insufficiency is a rare but well-defined consequence of non-penetrating chest trauma. The injury may occur as an isolated incident, and occasionally is induced through straining or relatively minor degrees of concussion. Unlike disruption of the thoracic aorta, which is associated with a high, early mortality, the torn aortic valve frequently permits a longer period of survival. Effective treatment during this time interval was not forthcoming, however, until the advent of cardiopulmonary bypass and the development of valvular prostheses.

During the past decade, traumatic aortic valve incompetence has received attention repeatedly, particularly after vehicular accidents. Our experience with a case of aortic leaflet injury is presented and compared with recent reports in the world literature.

Report of a case

A 19-year-old white male factory worker was driving at high speed when his car struck a utility pole. The steering wheel struck the midportion of his sternum. He was taken to a nearby hospital and found to have a compound comminuted fracture of the right patella and an avulsion fracture of the inferior pole of the left patella. No cardiac murmur was detected during this initial examination. During the second day of hospitalization, he had shortness of breath and chest pain. Auscultation then revealed a high-pitched, loud, diastolic murmur at the cardiac base. Dyspnea increased that day and became associated with a cough that produced yellowish-pink sputum. A diuretic and digitalis were administered and he was transferred to the Cleveland Clinic Hospital.

Physical examination. The patient was sitting upright and obviously . . .



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