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A previously well patient aged 20-plus years, underwent laparotomy following abdominal stab injuries. Bowel lacerations were identified and closed. Through a diaphragmatic defect, a small right atrial puncture was noted which was closed with cardiothoracic surgical assistance. No further injuries were identified. The patient was intubated and ventilated and on inotropic support with a blood pressure of 140/40 mm Hg. The patient's blood pressure later dropped to 100/30 mm Hg and plans were made for further abdominal imaging and re-laparatomy. In the meantime, transthoracic echocardiography (TTE) showed good left and right ventricular function and there was no pericardial effusion. However, the echocardiogram suggested severe aortic regurgitation (figure 1A), and there was a suspicious colour Doppler flow signal noted (figure 1B) through which continuous-wave Doppler velocities were recorded (figure 1C).
Contributors ASML, PRG and CAM wrote the manuscript, with RA, AMB and ICC editing it subsequently. RA and AMB obtained the echocardiographic pictures and videos, and the patient was under the care of ICC. ASML takes responsibility for the overall content as guarantor.
Competing interests None.
Provenance and peer review Not commissioned; internally peer reviewed.