Cardiovascular Journal of Africa: Vol 25 No 5 (September/October 2014)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 5, September/October 2014 AFRICA e5
Case Report
Traumatic aortic regurgitation combined with
descending aortic pseudoaneurysm secondary to blunt
chest trauma
Siho Kim, Joon Suk Park, Seung Min Yoo, Kyung Ho Kim, Woo-In Yang, Jung-Hoon Sung, In Jai Kim,
Sang-Wook Lim, Dong-Hun Cha, Jae-Youn Moon
Abstract
Rupture of the aorta is a relatively rare complication of blunt
chest trauma, and traumatic rupture of the aortic valve is
even rarer. Even though both result from blunt chest trauma,
the causative mechanisms of aortic valve injury differ from
those of descending aortic rupture. There are no previous
reports in the literature of simultaneous injuries to both the
descending aorta and the aortic valve. We report a case of a
70-year-old man who presented with traumatic aortic regur-
gitation combined with traumatic pseudoaneurysm of the
aortic isthmus following blunt chest trauma, and its successful
repair with a hybrid surgical strategy.
Keywords: chest trauma, aortic regurgitation, aortic pseudo-
aneurysm
Submitted 3/4/14, accepted 25/6/14
Cardiovasc J Afr 2014; 25: e5–e8
DOI: 10.5830/CVJA-2014-039
Acute traumatic aortic injury is a rare complication of blunt
chest trauma that can lead to aortic rupture, and traumatic
aortic regurgitation is an extremely rare complication of cardiac
trauma.1-3 Both complications generally originate after severe
multiple injuries to the thorax. However, it is known that the
causative mechanisms of aortic valve injury differ from those of
descending aortic injury.2
There are a few reports in the literature concerning single
lesions or aortic valve injury together with ascending aortic
rupture.3 However, to the best of our knowledge, there are
no previous case reports of simultaneous injuries to both
the descending aorta and the aortic valve. We report a case
of a 70-year-old man who presented with traumatic aortic
regurgitation combined with traumatic aortic pseudoaneurysm
of the aortic isthmus following blunt chest trauma.
Case report
A 70-year-old man was admitted to our hospital after a car
accident. He had a medical history of hypertension over the
past three years but no past history of suspected cardiovascular
disease such as valve disease or thoracic aortic aneurysm.
On physical examination, there was tenderness on the left chest
wall. A chest X-ray revealed multiple rib fractures and minimal
left haemothorax. Since the patient’s vital signs were stable,
conservative treatment for the fracture and the haemothorax was
initially agreed on. However, soon after, he developed dyspnoea,
dizziness and general weakness.
On further physical examination, a diastolic murmur was
detected at the aortic arch, and transoesophageal echocardio-
graphy (TEE) revealed acute severe aortic regurgitation
with rupture of the non-coronary cusp (Fig. 1A, B). Repeat
chest X-ray also revealed aggravated pulmonary congestion.
Additionally, images of computed tomography showed a small
saccular pseudo-aneurysm at the isthmic portion of the aorta,
which was suspected to be of traumatic origin (Fig. 1C, D).
The staged hybrid approach was chosen, which is aortic valve
replacement followed by thoracic endovascular aneurysm repair
to address both the aortic valve and the aortic isthmus injuries.
The aortic valve replacement was performed one week after the
accident.
The perforation of the non-coronary cusp was identified
during surgery and the residual remnant of the cusp was found
to be torn. Otherwise, the other coronary cusps were grossly
normal. The aortic valve was removed and replaced with a
bioprosthetic valve (Sorin Soprano no 22) (Fig. 2A, B). In
addition, a stent graft (34 × 100 mm) was performed for the
pseudo-aneurysm in the descending thoracic aorta 10 days after
the valve operation (Fig. 2C, D).
Department of Thoracic and Cardiovascular Surgery, CHA
Bundang Medical Center, CHA University, Seongnam, Korea
Siho Kim, MD
Joon Suk Park, MD
Department of Diagnostic Radiology, CHA Bundang
Medical Center, CHA University, Seongnam, Korea
Seung Min Yoo, MD
Department of Cardiology, CHA Bundang Medical Center,
CHA University, Seongnam, Korea
Kyung Ho Kim, MD
Woo-In Yang, MD
Jung-Hoon Sung, MD
In Jai Kim, MD
Sang-Wook Lim, MD
Dong-Hun Cha, MD
Jae-Youn Moon, MD, PhD,