Early diagnosis of traumatic aortic valve rupture in ICU patients using transoesophageal echocardiography.

A case is presented of a 60-year-old man who sustained spinal and chest wall injuries following a collision between his glider and an aeroplane. The severity of his injuries required him to be managed with bilateral underwater seal drains, cervical spine stabilisation and sedation with mechanical ventilation. Due to the severity of his chest trauma, a transoesophageal echocardiograph was performed which revealed a partial dehiscence and prolapse of the left coronary cusp of the aortic valve with mild to moderate aortic regurgitation. Despite conservative treatment, severe cardiac failure developed six days later requiring aortic valve replacement. After a prolonged stay in the Intensive Care Unit during which the patient developed acute respiratory distress syndrome, methicillin resistant Staphylococcus aureus pneumonia and Enterobacter septicaemia, the patient was discharged, returning to his pre-admission lifestyle. In patients with complex and severe chest trauma, transoesophageal echocardiography is of great benefit, not only in allowing good image quality, compared with transthoracic echocardiography, but having a greater reliability and accuracy in diagnosing cardiac and mediastinal trauma in complex monitoring environments.