From the Guidelines
Trauma can cause aortic regurgitation through damage to the aortic valve or aortic root, and prompt recognition and treatment are critical for survival, as stated in the 2021 ACC/AHA guideline for the management of patients with valvular heart disease 1.
Mechanisms of Injury
Trauma can lead to aortic regurgitation through several mechanisms, including:
- Blunt chest trauma, which can cause tearing or rupture of the aortic valve leaflets, leading to incompetence and backward flow of blood into the left ventricle during diastole
- Aortic root dilation or disruption of the commissures, compromising valve closure
- Deceleration injuries, which can create shearing forces that tear the aorta just above the valve, affecting valve function
- Penetrating trauma, which can cause direct injury to the valve leaflets
Clinical Presentation and Management
Post-traumatic aortic regurgitation may develop acutely, causing sudden heart failure with symptoms like shortness of breath, chest pain, and hypotension, or it may develop gradually if the initial damage is less severe.
Diagnosis and Treatment
Early recognition through physical examination (looking for a diastolic murmur) and echocardiography is crucial for proper management of this potentially life-threatening condition, as recommended by the European Association of Cardiovascular Imaging and the Acute Cardiovascular Care Association 1. The use of echocardiography, particularly transesophageal echocardiography (TOE), is essential in diagnosing and managing acute traumatic aortic injuries, and can help identify the mechanism of injury and guide surgical repair or replacement 1.
From the Research
Trauma and Aortic Regurgitation
- Trauma can cause aortic regurgitation due to various mechanisms, including rupture of the aortic valve cusps or damage to the aortic root 2, 3.
- Blunt chest trauma, in particular, can lead to aortic valve regurgitation, which may not always be immediately apparent and can present late with long-term consequences 2, 3.
- The diagnosis of aortic regurgitation due to trauma can be made using echocardiography, which can assess the severity of the regurgitation and its effect on left ventricular size and function 4, 5, 6.
Mechanisms of Trauma-Induced Aortic Regurgitation
- Rupture of the aortic valve cusps, such as the right coronary cusp or left coronary cusp, can occur due to trauma, leading to severe aortic regurgitation 2, 3.
- Damage to the aortic root can also cause aortic regurgitation, although this is less common 5, 6.
- The force of the trauma can cause sudden increases in left ventricular volume, leading to acute aortic regurgitation, which is a medical emergency 4.
Clinical Presentation and Management
- Patients with trauma-induced aortic regurgitation may present with symptoms such as chest pain, shortness of breath, and fatigue, although some may be asymptomatic 3.
- Echocardiography is essential for diagnosing and assessing the severity of aortic regurgitation, and cardiac magnetic resonance imaging may also be used in some cases 4, 5, 6.
- Management of trauma-induced aortic regurgitation typically involves surgical intervention, such as aortic valve replacement, although medical therapy with vasodilators may be used in some cases to delay the need for surgery 4, 5, 6.