Repair of Aortic Regurgitation Caused by Spontaneous Avulsion of Aortic Valve Commissure in a Patient with Idiopathic Thrombocytopenic Purpura

Abstract

We describe a case of severe acute aortic regurgitation in a 60-year-old woman due to spontaneous avulsion of an aortic valve commissure. She presented with spontaneous bleeding and a platelet count of 4 000/µl caused by idiopathic thrombocytopenic purpura and developed acute heart failure and respiratory insufficiency. Preoperative transesophageal echocardiography was not diagnostic for the exact mechanism of aortic regurgitation. She received a 2-day course of intravenous immunoglobulin (0.5 mg/kg/d) to increase platelet count. At operation detachment (avulsion) of the commissure between the left and the right coronary cusp was evident. Aortic valve repair was performed with resuspension of the commissure. The postoperative course was uneventful. During a 24-month follow-up period, the patient has remained in NYHA class I.

Key words

Aortic disease - cardiovascular surgery - heart valve surgery

References

• 1 Carter J B, Sethi S, Lee G B, Edwards J E. Prolapse of semilunar cusps as causes of aortic insufficiency.  Circulation. 1971;  43 922-932
• 2 Newcomb A E, Rowland M A. Non-traumatic localized dehiscence of the proximal ascending aorta through an aortic valve commissure.  Ann Thorac Surg. 2004;  78 321-323
• 3 Akiyama K, Hirota J, Taniyasu N, Maisawa K, Kobayashi Y. Echocardiographic and surgical findings of spontaneous avulsion of the aortic valve commissure.  Circ J. 2004;  68 254-256
• 4 Kupersmith A C, Belkin R N, McClung J A, Moggio R A. Aortic valve commissural tear mimicking type A aortic dissection.  J Am Soc Echocardiogr. 2002;  15 658-660
• 5 Hirata K, Kakazu M, Wake M et al. Acute aortic valvular regurgitation secondary to avulsion of aortic valve commissure in a patient with pseudoxanthoma elasticum.  Intern Med. 2000;  39 940-942
• 6 Mok C K, Tso J W, Aung Khin M. Dehiscence of an atheromatous plaque at an aortic valve commissure: an unusual cause of acute aortic regurgitation.  Br Heart J. 1988;  59 513-515
• 7 Mathew T C, Vasudevan R, Leb L, Pezzella S M, Pezzella A T. Coronary artery bypass grafting in immune thrombocytopenic purpura.  Ann Thorac Surg. 1997;  64 1059-1062
• 8 Christiansen S, Rötker J, Roeder N et al. Are patients with Werlhof's disease at increased risk for bleeding complications when undergoing cardiac surgery?.  Eur J Cardiothorac Surg. 2000;  18 353-356