A Case Report of Delayed Onset of Severe Aortic Regurgitation Due to Commissural Detachment After Low-Energy Blunt Chest Trauma: Timing is Key

Background Valve injury is a rare complication of blunt chest trauma (BCT). Although many cases result from high-energy BCT, it is important to recognize that low-energy trauma can also lead to serious cardiac complications, depending on the timing of the applied force. Herein, we present a case of delayed traumatic aortic regurgitation (AR) following low-energy BCT. Case summary A 77-year-old man presented with acute heart failure due to severe AR two months after a minor fall. Echocardiography revealed commissural detachment between the left and noncoronary cusps. He underwent aortic valve replacement owing to uncontrolled heart failure and severe AR. Discussion This case demonstrates delayed traumatic AR following low-energy BCT, a presentation less common than its typical association with high-energy trauma. However, AR can occur after minor trauma, particularly if the impact takes place during early diastole. The noncoronary cusp (NCC) is most frequently involved. In this case, detachment occurred at the commissure between the NCC and the left coronary cusp (LCC). Patients with acute and severe AR require prompt surgical intervention. This case emphasizes the importance of considering follow-up echocardiography in patients with persistent or progressive cardiac symptoms, even after minor chest trauma.