SURGICAL-MANAGEMENT OF AORTIC-VALVE INJURY AFTER NONPENETRATING TRAUMA

A case report and a literature review of the patients who underwent surgical repair of an aortic valve injury secondary to nonpenetrating trauma are presented. Thirty-seven patients (32 male and 5 female patients) with a median age of 43 years sustained either blunt chest trauma (34 patients) or muscular strain (3 patients) as a cause of injury. Primary repair was undertaken on 4 patients before 1964 (when the first aortic valve replacement was performed for this condition) and on 6 other patients after 1964. In the former group, 2 patients died because of heart failure and 1 subsequently required a prosthesis. The last patient had an excellent result at 17 years. In the latter group, 1 patient with a complex lesion had persistent moderate aortic regurgitation. The 5 remaining patients had a simple lesion to the valve and showed excellent results on follow-up evaluation (ranging from 6 months to 6 years). Aortic valve replacement successfully corrected the valvular dysfunction in 26 patients. Except for 1 case of hemolytic anemia, specific complications of prosthesis were not encountered, but median follow-up of this review was only 9 months. A modulated approach to this condition is proposed where primary repair is selected for cases with a simple tear or avulsion of one cusp. Intraoperative control of the repair by transesophageal echocardiography increases the safety of this approach. Valve replacement is indicated for more complex lesions or for ineffective primary repair as assessed by intraoperative echocardiography. Possibilities of associated injuries to the left ventricle (encountered four times) or the aorta (ten times) and its main branches (one time) necessitate a thorough evaluation of the heart and the aorta with at least an echocardiogram, a ventriculogram, and a thoracic aortogram.