Post-traumatic acute aortic regurgitation due to cusp rupture in non-calcific bicuspid valve treated with ballon-expandable transcatheter heart valve.

Abstract

A 65-year-old male truck driver was admitted to the emergency department after a road crush with consequent polytrauma. Patient’s past medical and cardiovascular history were unremarkable. Physical examination showed neck haematoma with multiple contusions, abolished right vesicular murmur, bone deformities. Whole-body CT scan documented multiple bone fractures, right hemothorax and pneumothorax, mediastinal haematoma, bilateral pulmonary contusions and rib fractures, dissection not limiting flow of right subclavian artery, left vertebral artery and both internal carotid arteries with associated pseudoaneurysms. Emergency chest drainage was performed and the patient was intubated because of worsening dyspnoea. Transthoracic echocardiography documented massive aortic insufficiency due to cusp rupture (Panels A and B and Supplementary material online, Videos S1 and S2) in the context of aortic bicuspidia (Sievers Type 1) and pulmonary hypertension with signs of right ventricular dysfunction. Because of patient’s extremely critical condition with hemodynamic instability and pulmonary congestion and concomitant prohibitive surgical risk for urgent aortic valve replacement, off-label transcatheter aortic valve replacement was planned.