title: Nontraumatic avulsion of aortic valve commissure as a cause of acute aortic valve regurgitation: A case report.
abstract: BACKGROUND
  Avulsion of the aortic valve commissure as a cause of acute aortic valve regurgitation is mostly due to trauma, infective endocarditis, or ascending aortic dissection. Nontraumatic avulsion of the aortic valve commissure is very rare. We reviewed the literature and analyzed potential risk factors of nontraumatic avulsion.
  
  
  METHODS
  An 80-year-old male with hypertension was seen in the emergency department with acute onset dyspnea. Echocardiogram revealed left ventricular hypertrophy with adequate systolic function, prolapse of the noncoronary cusp, and incomplete coaptation of the right coronary and noncoronary cusps with severe aortic valve regurgitation. Surgery revealed an avulsion between the left coronary and noncoronary cusps. Histopathology examination of the aortic valve showed myxoid degeneration, fibrosis, and calcification. Examination of the ascending aorta revealed myxoid degeneration and fragmentation of elastic fibers. Aortic valve replacement was performed, and the patient was alive and well 4 years after surgery. A review of the literature showed that more than three-fourths of the similar cases occurred in males, and about half in patients with hypertension and those 60 years of age or older.
  
  
  CONCLUSIONS
  In the case of acute aortic regurgitation without a history of trauma, infection, or valvotomy, when 2 prolapsed aortic cusps are observed by echocardiography in the absence of an intimal tear of the ascending aorta, an avulsion of the aortic commissure should be suspected, especially in males with hypertension who are 60 years of age or older.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi Department of Beauty and Health Care, Min-Hwei Junior College of Health Care Management, Tainan Department of Nursing, Chung-Jen Junior College of Nursing, Health Sciences and Management Division of Cardiovascular Surgery, Department of Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi Division of Family Medicine, Cheng Ching General Hospital Division of Hematology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung Department of Pathology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi Department of Occupational and Environmental Medicine, National Cheng Kung University and Hospital, Tainan, Taiwan.
authors.forename: Rei-Yeuh
authors.initials: RY
authors.lastname: Chang
authors.forename: Chien-Chang
authors.initials: CC
authors.lastname: Chen
authors.forename: Wei-Pang
authors.initials: WP
authors.lastname: Hsu
authors.forename: Pei-Ching
authors.initials: PC
authors.lastname: Hsiao
authors.forename: Han-Lin
authors.initials: HL
authors.lastname: Tsai
authors.forename: Ping-Gune
authors.initials: PG
authors.lastname: Hsiao
authors.forename: Jiann-Der
authors.initials: JD
authors.lastname: Wu
authors.forename: How-Ran
authors.initials: HR
authors.lastname: Guo
mesh_terms: D000208:Acute Disease; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D004452:Echocardiography; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D012720:Severity of Illness Index