High-Risk Repair of Traumatic Mitral Valve Rupture in the Setting of Polytrauma

Abstract

IntroductionCardiac valvular injury after blunt trauma is an unusual etiology of shock and merits a high index of suspicion for diagnosis. The majority of mitral valve (MV) injuries involve the papillary muscles or chordae tendinae with repair tailored at the underlying pathology. Few reports of MV injury in the setting of trauma exist with the largest review totaling 82 cases in a 2009 publication.1 We report a case of cardiogenic shock due to MV insufficiency in setting of polytrauma. Case DescriptionA 56-year-old woman with a history of depression presented after a fall of 30 m, reportedly landing upon bushes cushioning her impact. Admission blood pressure was 88/48 mm Hg and pulse was 110 bpm. Physical examination and chest radiograph were unremarkable for any significant signs of trauma. Cross-sectional imaging revealed multiple rib fractures, right pneumothorax, splenic, renal and liver lacerations, cervical and thoracic spine fractures, an ulnar fracture, and a spinal epidural hematoma (SEH). Her calculated injury severity score was 29 and trauma score-injury severity score predicting 24.4% likelihood of death. AbstractBackground The rare complication of mitral valve rupture from blunt trauma is certainly not at the top of the differential of shock. Case Description We report the case of a 56-year-old woman who sustained numerous injuries after a 30-m fall with cardiogenic shock secondary to mitral valve rupture causing severe mitral valve regurgitation. Management included successful primary leaflet repair, annuloplasty, and single vessel coronary artery bypass. Conclusion Valvular repair in the setting of polytrauma is a complex decision that requires careful balance of risks and benefits relative to patient stability.

Mitral valve repair in severe mitral regurgitation after blunt chest trauma

“…Acute traumatic severe mitral regurgitation warrants the need for definitive treatment once hemodynamic stability has been ideally achieved [6] . However, the decision remains as a case-by-case multidisciplinary approach depending on the risks and benefits considered on the patient status.…”

“…Echocardiography should always be performed in patients with blunt chest trauma in the emergency department. This is the most sensitive diagnostic test as well as an excellent tool guiding the therapy because of its capacity to describe the underlying mechanism of the lesion [6] , [7] . If aortic or mitral valve injury is suspected, a transesophageal echocardiography has been demonstrated to be safe in critically ill patients and should be considered in patients with poor acoustic windows 4.…”