title: Sudden deterioration of aortic regurgitation due to rupture of a raphal cord on the conjoined cusp.
abstract: A 57-year-old man was admitted to hospital for acute myocardial infarction associated with mild aortic regurgitation, which was successfully treated by intracoronary thrombolysis. Twenty-four days later, he suffered from another chest pain attack without any electrocardiographic ST-T changes. The coronary angiogram did not show any significant lesions, but the aortic root angiogram showed massive aortic regurgitation. Surgery revealed a bicuspid aortic valve with a conjoined cusp that had a fenestrated raphe torn away from the aortic wall and prolapsing into the left ventricle. The aortic valve was successfully replaced with a St Jude Medical mechanical valve prosthesis. The pathological significance of the intact raphal cord and the rupture remains an unsolved problem. This is the first reported case in which an increase of aortic regurgitation due to a ruptured raphal cord supporting the conjoined cusp was confirmed by a serial root angiogram.
authors.affiliation: Department of Cardiovascular Surgery, Iwaki Kyoritsu General Hospital, Fukushima, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Akiyama
authors.forename: N
authors.initials: N
authors.lastname: Taniyasu
authors.forename: Y
authors.initials: Y
authors.lastname: Iba
authors.forename: J
authors.initials: J
authors.lastname: Hirota
authors.forename: S
authors.initials: S
authors.lastname: Asano
mesh_terms: D001022:Aortic Valve Insufficiency; D006351:Heart Valves / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012421:Rupture