Flail aortic valve leaflet due to high-voltage electrical injury

    Authors

    Keywords

    flail aortic valve leaflet, aortic regurgitation, electric injuries

    DOI

    https://doi.org/10.15836/ccar2019.85

    Full Text

    Introduction: Electric shock is the set of pathophysiological events resulting from the action of an electric current on the human body ( 1 ). Electrical injuries involve both direct (caused by contact with electricity arc) and indirect mechanisms (mechanical trauma due to falls). The most common sequels after electrical injury in the heart are arrhythmias and myocardial contusion ( 2 ). Large arteries like aorta are rarely affected because their rapid flow allows them to dissipate the heat produced by the electric current. However, they are susceptible to medial necrosis, with aneurysm formation and rupture at a later point of time. There is one case in the literature which described aortic valve rupture due to high-voltage electrical injury ( 3 ). Case report: 47-year-old male patient was admitted to our echo lab for ultrasound examination of the heart. In the last two months he had been complaining about exertional dyspnea. His medical history was quite poor: he had never been admitted to the hospital until two months ago when he had been observed for 24 hours after he had suffered a high-voltage electric injury. The transthoracic echocardiography was performed, and we discovered moderately enlarged left ventricle (LVED volume 180 ml) due to severe aortic regurgitation on bicuspid aortic valve with holo-diastolic retrograde flow. The regurgitation jet that filled the two thirds of left ventricular outflow tract with laceration and flail of bicuspid cusps confirmed on transesophageal ultrasound. The patient underwent surgery. The aortic valve was removed and replaced with a mechanical prosthesis. Conclusion: Cardiac symptoms and echocardiographic findings that initiated two months after a high-voltage electric injury led us to conclusion that bicuspid valve was probably injured by electrical shock. To the authors’ knowledge, this is the first reported case of valvular rupture due to electrical injury in Croatian population.

    Cardiologia Croatica
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    Flail aortic valve leaflet due to high-voltage electrical injury

    Extended Abstract
    Issue3-4
    Published
    Pages85
    PDF via DOIhttps://doi.org/10.15836/ccar2019.85
    flail aortic valve leaflet
    aortic regurgitation
    electric injuries

    Authors

    Josip Katić*ORCIDUniversity Hospital Centre Split, Split, Croatia
    Mijo MeterORCIDUniversity Hospital Centre Split, Split, Croatia
    Antonia MeladaORCIDUniversity Hospital Centre Split, Split, Croatia
    Ivona MustapićORCIDUniversity Hospital Centre Split, Split, Croatia
    Viktoria LišnićORCIDUniversity Hospital Centre Split, Split, Croatia
    Darija Baković KramarićORCIDUniversity Hospital Centre Split, Split, Croatia

    Full Text

    Introduction: Electric shock is the set of pathophysiological events resulting from the action of an electric current on the human body ( 1 ). Electrical injuries involve both direct (caused by contact with electricity arc) and indirect mechanisms (mechanical trauma due to falls). The most common sequels after electrical injury in the heart are arrhythmias and myocardial contusion ( 2 ). Large arteries like aorta are rarely affected because their rapid flow allows them to dissipate the heat produced by the electric current. However, they are susceptible to medial necrosis, with aneurysm formation and rupture at a later point of time. There is one case in the literature which described aortic valve rupture due to high-voltage electrical injury ( 3 ). Case report: 47-year-old male patient was admitted to our echo lab for ultrasound examination of the heart. In the last two months he had been complaining about exertional dyspnea. His medical history was quite poor: he had never been admitted to the hospital until two months ago when he had been observed for 24 hours after he had suffered a high-voltage electric injury. The transthoracic echocardiography was performed, and we discovered moderately enlarged left ventricle (LVED volume 180 ml) due to severe aortic regurgitation on bicuspid aortic valve with holo-diastolic retrograde flow. The regurgitation jet that filled the two thirds of left ventricular outflow tract with laceration and flail of bicuspid cusps confirmed on transesophageal ultrasound. The patient underwent surgery. The aortic valve was removed and replaced with a mechanical prosthesis. Conclusion: Cardiac symptoms and echocardiographic findings that initiated two months after a high-voltage electric injury led us to conclusion that bicuspid valve was probably injured by electrical shock. To the authors’ knowledge, this is the first reported case of valvular rupture due to electrical injury in Croatian population.