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Cardiovascular Images

Echocardiographic and Macroscopic Images

Aortic Cusp Laceration

Demetrio Tallarico, MD; Pier Andrea Chiavari, MD and Giuseppe Campolongo, MD

From the Department of Heart and Great Vessels "Attilio Reale," "Sapienza," University of Rome, Rome, Italy.

Correspondence to Pier Andrea Chiavari, MD, Località Colle Farnese snc, 01036-VT, Italy. E-mail pierandreachiavari@libero.it

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 70-year-old man was admitted to our department for non–ST-segment elevationmyocardial infarction. His risk factors were hypertension, diabetes, dyslipidemia, and smoking. On admission, physical examination and enzymatic markers of myocardial injury were normal. The ECG revealed T-wave inversion in leads V1–V6. Transthoracic echocardiography showed mild left ventricular hypertrophy. Cardiac catheterization revealed severe triple coronary artery disease. Three days after coronary angiography, the patient had dyspnea at rest, and, on physical examination, tachycardia and a diastolic murmur were present. A second transthoracic echocardiography revealed the presence of a filamentous image on the aortic valve and severe asymmetrical aortic regurgitation (Figure 1). Transesophageal echocardiography confirmed the presence of the filamentous arising from the right aortic cusp and severe aortic regurgitation (Figures 2 and 3). All Duke criteria were negative. This image could be in differential diagnosis with an endocarditis infection, a giant Lambl excrescence, or a papillary fibroelastoma.

View larger version (130K):   Figure 1. Apical modified 4-chamber view shows a mobile and filamentous mass in the left ventricular outflow tract (arrow).

 

View larger version (104K):   Figure 2. Transesophageal echocardiography revealed an isoechogenic and filamentous structure arising from the right aortic cusp.

 

View larger version (111K):   Figure 3. Severe regurgitation in the color 2D transesophageal view.

 
Surgery performed 4 days later showed multiple tiny fenestrations of the left and noncoronary cusps of the aortic valve (Figure 4) and a laceration of the right coronary cusp (Figures 4 and 5), with the free margin prolapsing into left ventricular outflow tract. Valve repair failed because of shrinking of the . . . [Full Text of this Article]