Severe Aortic and Tricuspid Valve Regurgitation after Blunt Chest Trauma: An Unusual Presentation

Case Report: Lessons Learned From Aortic Valve Rupture After Blunt Chest Trauma

“…Patients with BCT should be repeatedly evaluated by physical examination and echocardiography to rule out cardiac injuries, especially valvular damage with an insidious onset and a slow progression. TEE should be performed to visualize intracardiac structures better if the images of TTE are suboptimal due to mechanical ventilation or other coexistent injuries (9). AVR should be highly suspected in patients presenting with widened pulse pressure, pulmonary edema, pulmonary hemorrhage, and diastolic heart murmur at the left lower sternal border.…”

Traumatic Injury to Both Atrioventricular Valves

“… 10 In particular, TEE is superior to TTE as it typically affords excellent views of the valvular and subvalvular structures and image quality is less affected by body habitus, mechanical ventilation, and the presence of surgical drains. 10 , 11 , 12 Other methods of assessing cardiac function, such as troponin and ECG, are useful screening tools but are nonspecific, and abnormalities are often transient. 13 In this case, TEE was useful for characterizing the mitral valve pathology.…”

“…However, failure to be able to fully appreciate the extent of BCI with early TTE has been described in another recent case report involving injury to the aortic and tricuspid valves. 12 A second reason for delayed diagnosis is that valvular function may deteriorate over time following the initial injury due to damaged tissue subsequently becoming necrotic or forming a weak scar with subsequent rupture. 8 , 9 , 11 , 12 , 13 Late presentations of valvular dysfunction, weeks and even several months after initial injury, have been reported.…”

“… 12 A second reason for delayed diagnosis is that valvular function may deteriorate over time following the initial injury due to damaged tissue subsequently becoming necrotic or forming a weak scar with subsequent rupture. 8 , 9 , 11 , 12 , 13 Late presentations of valvular dysfunction, weeks and even several months after initial injury, have been reported. 7 , 12 In this patient, the presence of severe thoracic trauma in association with hemodynamic instability raised the possibility of BCI.…”

“… 8 , 9 , 11 , 12 , 13 Late presentations of valvular dysfunction, weeks and even several months after initial injury, have been reported. 7 , 12 In this patient, the presence of severe thoracic trauma in association with hemodynamic instability raised the possibility of BCI. The initial TEE examination was performed shortly after the patient presented to the referring hospital.…”