[Traumatic aortic regurgitation: report of two surgical cases]

Two successful surgical cases with aortic regurgitation due to blunt trauma are reported. Case 1: A 48-year-old female was transferred to our hospital after a traffic accident. She was intubated and mechanically ventilated. Twelve days later, echocardiography demonstrated massive aortic regurgitation. The next day, aortic valve replacement was performed using a 21 mm SJM mechanical valve. The central part of the non-coronary cusp was torn and perforated 15 mm long. She is in good condition three years after surgery. Case 2: A 57-year-old male was transferred to the nearest hospital because he was involved in a snowslide accident. A month after the injury, catheterization showed massive aortic regurgitation and pulmonary hypertension. An aortotomy revealed that the intima around the right coronary ostium was completely torn. A perforation with a diameter of 3 mm was also observed on the right coronary cusp. After coronary cusps were excised, interrupted mattress sutures buttressed with pledgets were passed through the aortic wall at the distal level of the intimal laceration and then to the aortic annulus. A 25 mm SJM prosthetic valve was seated at the aortic ring. As the right coronary ostium was included in the plicated aortic wall, aortocoronary bypass was constructed using the great saphenous vein. He is doing well 14 months after surgery. Aortic regurgitation due to blunt trauma is rare and difficult to diagnose. Sometimes cardiac failure progresses rapidly. Therefore, urgent surgery is recommended as soon as the diagnosis is confirmed.