Latent Avulsion of the Posterior Mitral Leaflet Base from the Mitral Annulus Following a Motor Vehicle Accident: A Case Report

Injuries to the heart and great vessels should always be considered after blunt chest trauma. Valvular damage rarely occurs after blunt trauma, but symptoms may be delayed. A 58-year-old woman was referred to our hospital with exertional dyspnea (functional class III) and palpitations for elective transesophageal echocardiography. Her symptoms had exacerbated in the preceding 2 or 3 months. Physical examination showed holosystolic murmurs (IV/VI) at the lower sternal border with extension to the apex. Transesophageal echocardiography revealed avulsion of the base of the posterior mitral valve leaflet (P3) from the annulus. In the past medical history, there was a history of a motor vehicle accident 9 months earlier. The patient was recommended for mitral valve surgery. Mitral valve replacement was performed, and the diagnosis was confirmed by surgery. The patient was discharged without any complications.

[1]  M. Walsh,et al.  Blunt Thoracic Trauma-Induced Mitral Papillary Muscle Avulsion with Pericardial Rupture and Cardiac Herniation: Difficult and Delayed Diagnoses , 2020, Case Reports in Surgery.

[2]  A. Facciorusso,et al.  Mitral Perivalvular Leak after Blunt Chest Trauma: A Rare Cause of Severe Subacute Mitral Regurgitation. , 2015, Texas Heart Institute journal.

[3]  T. Hsia,et al.  Concomitant repair of mitral valve papillary muscle rupture and tricuspid valve avulsion in a pediatric patient after a motor vehicle collision. , 2009, The journal of extra-corporeal technology.

[4]  C. Kan,et al.  Traumatic aortic and mitral valve injury following blunt chest injury with a variable clinical course , 2005, Heart.

[5]  C. Mestres,et al.  Acute aortic and mitral valve regurgitation following blunt chest trauma. , 2004, Interactive cardiovascular and thoracic surgery.

[6]  Wolfgang Goetz, Alexander Wahba, Natesa G. Pandian Mitral Valve Incompetence Following Blunt Chest Trauma After Mitral Valve Repair - Recognition by Three-dimensional Echocardiography , 2001 .

[7]  W. Goetz,et al.  Mitral valve incompetence following blunt chest trauma after mitral valve repair. Recognition by three-dimensional echocardiography. , 2001, Scandinavian cardiovascular journal : SCJ.

[8]  T. Kugai,et al.  Rupture in a mitral papillary muscle following blunt chest trauma. , 2000, The Japanese journal of thoracic and cardiovascular surgery : official publication of the Japanese Association for Thoracic Surgery = Nihon Kyobu Geka Gakkai zasshi.

[9]  A. Farmery,et al.  Delayed rupture of the mitral valve complicating blunt chest trauma. , 1998, Journal of accident & emergency medicine.

[10]  L. Conklin,et al.  Mitral valve injury from blunt trauma. , 1998, The Journal of heart valve disease.

[11]  T. Orszulak,et al.  Mitral valve injury after blunt chest trauma. , 1996, The Annals of thoracic surgery.

[12]  T. Shimokawa,et al.  [A case report of mitral valve plasty for traumatic mitral regurgitation]. , 1996, Kyobu geka. The Japanese journal of thoracic surgery.

[13]  F. Loop,et al.  Mitral valve repair for ischemic mitral insufficiency. , 1991, The Annals of thoracic surgery.

[14]  J. Hutchinson,et al.  Laceration of a mitral papillary muscle and the aortic root as a result of blunt trauma to the chest. Case report and review of the literature. , 1984, The Journal of thoracic and cardiovascular surgery.

[15]  M F Shiu,et al.  Mitral valve disease. , 1984, European heart journal.

[16]  S. Qureshi,et al.  Avulsion of the anterior papillary muscle of the mitral valve due to non-penetrating trauma to the chest. , 1982, Thorax.

[17]  A. Liedtke,et al.  Nonpenetrating cardiac injuries: a collective review. , 1973, American heart journal.

[18]  G. Burch,et al.  Gross morphology and arterial supply of the papillary muscles of the left ventricle of man. , 1969, American heart journal.

[19]  J. Kelly,et al.  The syndrome of mitral insufficiency due to isolated rupture of the chordae tendineae. , 1967, The American journal of medicine.

[20]  L. F. Parmley,et al.  Nonpenetrating Traumatic Injury of the Heart , 1958, Circulation.