POSTTRAUMATIC ACUTE AORTIC-VALVE INCOMPETENCE - ROLE OF TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN DIAGNOSIS OF THE LESIONS AND TREATMENT

A 58-year-old car driver suffered a road accident responsible for seve re blunt thoraco-abdominal trauma. Transoephageal echocardiography, pe rformed following the secondary development of a diastolic murmur, con firmed the presence of aortic incompetence due to commissural avulsion and guided the surgical treatment, which consisted of commissural sus pension under cardiopulmonary bypass via a mini transverse trans-stern al incision. The rarity of acute aortic valve incompetence following n on-penetrating thoracic trauma is illustrated by the data of the liter ature. This lesion is due to either avulsion of a sigmoid cusp or comm issure, or laceration of the valvular tissue. Transthoracic echocardio graphy confirms the reality of aortic incompetence suggested clinicall y by appearance of a diastolic murmur, but confirmation of the mechani sm of the lesions is based on transoesophageal echocardiography which allows perfectly safe and rapid visualization of the mechanism of the valvular lesion, investigation of associated lesions and guidance of t herapeutic management.