%0 Journal Article
%T Traumatic Mitral Valve and Pericardial Injury
%A Nissar Shaikh
%A Firdous Ummunissa
%A Mohamed Abdel Sattar
%J Case Reports in Critical Care
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/385670
%X Cardiac injury after blunt trauma is common but underreported. Common cardiac trauma after the blunt chest injury (BCI) is cardiac contusion; it is very rare to have cardiac valve injury. The mitral valve injury during chest trauma occurs when extreme pressure is applied at early systole during the isovolumic contraction between the closure of the mitral valve and the opening of the aortic valve. Traumatic mitral valve injury can involve valve leaflet, chordae tendineae, or papillary muscles. For the diagnosis of mitral valve injury, a high index of suspicion is required, as in polytrauma patients, other obvious severe injuries will divert the attention of the treating physician. Clinical picture of patients with mitral valve injury may vary from none to cardiogenic shock. The echocardiogram is the main diagnostic modality of mitral valve injuries. Patient¡¯s clinical condition will dictate the timing and type of surgery or medical therapy. We report a case of mitral valve and pericardial injury in a polytrauma patient, successfully treated in our intensive care unit. 1. Background Traumatic cardiac injury is one of the common unsuspected organ injuries leading to fatal outcome in polytrauma patients [1]. Cardiac injuries following blunt chest trauma vary from cardiac contusions to the fatal myocardial rapture. The cardiac injury occurs in up to 76% of the blunt chest trauma patients, but trauma to cardiac valves is a rare finding [1]. Rupture of papillary muscle or its tendinous cords following blunt trauma is a very rare etiology of the acute mitral regurgitation. We report a case of mitral valve and pericardial injury in a polytrauma patient, successfully treated in our intensive care unit. 2. Illustrated Case A 48 years old pedestrian was involved in a road traffic accident, and on admission, the Glasgow coma score (GCS) was 14/15, tachypneic (respiratory rate was 35 to 40/minute), tachycardic (heart rate was 120 to 140/minute), with systolic blood pressure 90£¿mm of Hg and oxygen saturation of 88% to 90% on 15 litres/minute of oxygen supplementation. He had a flail chest with decreased air entry on left side. Chest X-ray showed fractured ribs (1 to 7) on left side with hemopneumothorax. Immediate left chest drain was inserted. Initial computerized tomography (CT) scans reveled bilateral lung contusions with fractured ribs on left side. He had grade IV splenic injury and hemoperitoneum. An immediate laparotomy showed ruptured left diaphragm and mesenteric venous bleeding. Splenectomy with diaphragm repair and ligation of mesenteric vein was done.
%U http://www.hindawi.com/journals/cricc/2013/385670/