Author + information
- Received March 23, 2010
- Accepted April 5, 2010
- Published online September 1, 2010.
- ↵⁎Reprint requests and correspondence:
Dr. Benjamin Safar, GHI Le Raincy Montfermeil, Cardiology, 10 Rue du General Leclerc, Montfermeil, Ile de France 93370, France
A case of iatrogenic aortic regurgitation caused by laceration of a cusp fenestration of the aortic valve during diagnostic coronary angiography is presented. This complication was finally cured by aortic valve replacement. Images of transthoracic, 64-slice multidetector computed tomography, and macroscopic surgery pictures illustrate this case.
A 66-year-old man was admitted to our department for coronary disease. Physical examination was normal, without any heart murmur, and transthoracic echocardiography did not show evidence for valvular disease. Coronary angiography revealed triple-vessel disease with moderate left ventricular dysfunction and medical treatment was decided.
Following the procedure, a grade 3/6 diastolic murmur appeared. Transthoracic echocardiography revealed a severe aortic regurgitation, due to posterior cusp prolapse (Fig. 1A) confirmed by transesophageal echocardiography.
At 6 months, the patient developed severe dyspnea and surgery was planned. Cardiac 64-slice multidetector computed tomography reassessed coronary stenosis and showed the noncoronary cusp prolapse (Figs. 1B and 1C). Intraoperative findings were a rupture of posterior cusp fenestration, which was responsible for an 8-mm tear (Fig. 1D), and intact congenital fenestrations were also present on the right and left coronary cusps (Fig. 1E). Mechanical valve replacement combined with coronary artery bypass grafting was performed. The post-operative course was uneventful.
Aortic cusp fenestrations are frequent findings during aortic valve surgery for dystrophic aortic insufficiency (1–4). These congenital fenestrations are located in the paracommissural area, in the coaptation zone, and do not directly result in regurgitation when they are intact. Fenestrations consist of thin fibrous strands connecting the central part of the cusp to the commissure. In this case report, guide wires may have passed through the noncoronary cusp fenestration, leading to its rupture resulting in cusp prolapse and regurgitation. If the remaining cusps are macroscopically normal, valve repair might be performed as an alternative to prosthetic replacement.
All authors have reported that they have no relationships to disclose.
- Received March 23, 2010.
- Accepted April 5, 2010.
- American College of Cardiology Foundation
- Fundarò P.,
- Di Mattia D.G.,
- Cialfi A.,
- Santoli C.