Mitral valve injury after blunt chest trauma is a rare occurrence. We recently admitted a patient with severe traumatic mitral regurgitation who was successfully treated with surgery. Review of the literature aimed at taking an inventory of cases of traumatic nonpenetrating mitral insufficiency that were operated on, since the earliest report in 1964. Eighty-two cases were found and analyzed allowing for a better understanding of the epidemiology, etiology, natural history, pathology, and treatment of this rare condition. The most common lesions reach the papillary muscles (PM), followed by the chordae and then the mitral valve leaflets. Among the 82 cases reported that have been treated with surgery, 57% required a valve replacement. More than half of the patients had a PM injury with a complete or partial rupture. When the rupture is complete, and especially when it involves the anterior PM, the clinical picture is most always acute with clinically important hemodynamic repercussions, often necessitating emergency surgery, most of the time with mitral valve replacement. One must always suspect traumatic mitral injury after blunt chest trauma. The most common mitral lesions affect the PM. The clinical course can be indolent or devastating, and most often requires urgent or delayed surgical treatment, either with mitral valve repair or replacement.
From the Emergency Services (M.P., B.Y., P.-N.C.), Cardiology Service (C.S.), and Department of Cardiosurgery (D.D.), University Hospital Center (CHUV), Lausanne, Switzerland.
Submitted for publication June 7, 2009.
Accepted for publication August 10, 2009.
Address for reprints: Mathieu Pasquier, MD, Service des Urgences, Rue du Bugnon 46, 1011 Lausanne, Switzerland; email: Mathieu.Pasquier@chuv.ch.
The complete list of references used to pool the 82 cases of mitral valve injury after blunt chest trauma are available from the corresponding author.