Acute aortic regurgitation due to spontaneous rupture of a fenestrated cusp: Report in a 65-year-old man and review of seven additional cases

A 65-year-old man with chronic hypertension developed dyspnea, a cough, and a new diastolic murmur. Two-dimensional echocardiography showed severe aor tic regurgitation. No valvular vegetations were identified and blood cultur es were negative. Surgical intervention was recommended, but the patient di ed of an acute intracranial hemorrhage two weeks later. At autopsy, the pos terior aortic cusp was flail, due to rupture of the residual cord above two large fenestrations. There was no acute or healed endocarditis. To our kno wledge, this is the eighth reported case of aortic valve incompetence due t o spontaneous rupture of a fenestrated cusp. Patients ranged in age from 31 -67 years (mean, 54), and 4 (50%) were older than 60 years, Seven (88%) of the 8 were men, and 4 (57%) of 7 had chronic hypertension. Analogously, in another four reported cases, aortic insufficiency developed following spont aneous rupture of the fenestrated raphe of an atypical congenitally bicuspi d aortic valve. Noninfective and nontraumatic rupture of cord-like aortic v alve structures may result in severe acute aortic regurgitation, particular ly in men with chronic hypertension. (C) 1999 by Elsevier Science Inc.