Aortic valve perforation

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      This paper describes fifteen patients with aortic valve perforation, in fourteen of whom this complication developed during the course of bacterial endocarditis. Aortic cusp perforation should be suspected whenever moderately severe or severe aortic insufficiency appears during bacterial endocarditis. The murmur of aortic insufficiency caused by cusp perforation is of the common decrescendo blowing quality, and is only occasionally of musical quality. In patients with aortic cusp perforation and attendant severe aortic insufficiency, congestive heart failure often develops within a few days or weeks. In our series heart failure appeared within one week to four and a half months in eleven of the fifteen patients. Eight of these patients, who had not been treated by aortic valve surgery, died within one day to six months after the appearance of heart failure. Three of our patients with acute bacterial endocarditis apparently died of a cardiac arrhythmia resulting from infection of the atrioventricular node or bundle of His. In seven of our patients the aortic insufficiency was treated surgically. In two patients the perforation was small enough to be closed by direct suturing; in five the aortic valve was excised and replaced by a Starr-Edwards prosthesis. Five of these seven patients survived to be discharged from the hospital, but one of the five died suddenly three months postoperatively, and another died of Candida endocarditis four and a half months after insertion of the prosthesis.
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