subacute aortic regurgitation as a rare presentation of iatrogenic aortic valve leaflet perforation

there is a paucity of literature regarding iatrogenic aortic valve perforation after cardiac operation is performed in the vicinity of the aortic valve. this report describes the clinical, echocardiographic, and angiocardiographic recognition of iatrogenic aortic valve perforation in a patient who had previously under gone membranous ventricular septal defect and pulmonary stenosis. five days after the operation, the patient showed subacute signs and symptoms of congestive heart failure in surgical ward. echocardiographic examination revealed free aortic regurgitation. the patient was scheduled for operation, which was performed using cardiopulmonary bypass and cardioplegic arrest. during the operation, exploration of the aortic root revealed tearing non-coronary aortic cusp at the level of the aortic ring and slightly dilated the left sinus. despite close examination, no suture could be identified. it was reasoned that the tension created by the dacron patch pulled on the adjacent tissue and caused the separation of the non-coronary cusp from its ring and the patient was treated by aortic valve replacement with prosthetic aortic valve. we did not have the facility to use transesophaseal echocardiography for the examination of aortic valve repair and the poor condition of the patient did not permit us to repair the valve. precise preoperative diagnosis of this lesion allows optimal surgical planning and treatment.