Papillary Muscle Injury after Blunt Chest Trauma

Abstract

In many cases blunt chest trauma involves cardiac lesions, such as pericardial effusion, aneurysma dissecans, or valvular rupture. Early diagnosis with routine transthoracic and/or transesophageal echocardiography is essential to prevent a fatal outcome. In the case reported, a previously healthy 68-year-old woman fell 7 meters from the roof of a barn and sustained blunt injury to the chest as well as fractures of the face. Physical examination revealed a systolic murmur at the cardiac apex, and chest x-ray film showed a severe pulmonary edema. Transesophageal echocardiography demonstrated a ruptured anterolateral papillary muscle with fourth degree mitral insufficiency. An immediate mitral valve replacement was necessary.

The right place, the right time

“…As seen in this case and others [2][3][4][5][6][7], expedient diagnosis and surgical valve replacement frequently lead to excellent functional recovery in patients with papillary muscle rupture. In the end, it all comes down to being in the right place at the right time.…”

“…Complete or even partial rupture of these muscles may yield severe mitral regurgitation [1][2][3][4][5][6][7][8]. Rupture of the papillary muscle is a mechanical complication most often seen in the aftermath of an acute myocardial infarction [6,8] or as a result of blunt trauma sustained in a fall [5,9] or auto accident [7,10]. Other causes of rupture include infection, such as that seen in endocarditis or clostridial sepsis [11].…”

Mitralklappeninsuffizienz nach stumpfem Thoraxtrauma

“…In den meisten Fällen sind Verkehrsunfälle mit Auto [2,17,18,22,23,29,36,37,51,54,62,66,67,69,70,78,79,84,[88][89][90]93] oder Motorrad [10,25,35,41,50,76] Ursachen der Klappenverletzungen. Nicht selten werden Stürze aus großer Höhe [6,46,52,80,94,96] und Schlageinwirkungen vor die Brust [12,15,32,33,63,75,87] als ursäch-lich beschrieben.…”

“…Eine weitere Kasuistik beschreibt den Fall einer traumatischen Mitralinsuffizienz mit Notwendigkeit einer Operation nach 7 Jahren aufgrund einer Mitralklappenendokarditis [3]. Traumatische Mitralinsuffizienzen sind auch bei Kindern berichtet worden [22,57,59,67,70,79,94].…”

“…So zählt eine Echokardiographie nicht zur Routineuntersuchung nach Thoraxtrauma. Grundlage der Diagnosestellung ist die Auskultation [76,94]. Echokardiographische Untersuchungen sind wegweisend für die Diagnose und Therapieentscheidung [36,66,68,71,82,85].…”