[A successful procedure in mitral valve rupture accompanied by rupture of the papillary muscle and the chordae tendinae following multiple injuries and blunt thoracic trauma].
In a considerable number of cases, blunt chest trauma also involves cardiac lesions including myocardial contusion or disruption pericardial effusion, or valve rupture. Definite cardiac trauma poses a challenge to everyone involved in intensive care, as early diagnosis and prompt treatment may be necessary to prevent a fatal outcome. We report a 32-year-old patient with fractures of the humerus, forearm, left clavicle and 2nd rib, and right ribs 4-6 after an 8 m fall. He was intubated in the emergency room because of arterial hypoxemia. Despite fluid administration the blood pressure deteriorated and the patient rapidly developed congestive heart failure that required huge doses of catecholamines. A systolic murmur was heard in the apex and left axilla. Conventional transthoracic echocardiography showed mitral valve prolapse and was suggestive of a flail mitral valve. Transesophageal echocardiography confirmed the diagnosis of mitral valve rupture, which proved to be grade IV by angiography. Because of continuous deterioration with low cardiac output and critical blood pressures and heart rates, surgery was carried out on the day of admission. Complete rupture of the anterolateral papillary muscle was found with laceration of the ventricular muscle, rupture of the secondary chordae tendineae, partial rupture of the valve base and partial dissection of the valve leaflets from the base. As expected from the echocardiography, there was no pericardial effusion. The destroyed valve was replaced by a Duromedics prosthesis. Operative stabilization of the subcapital humeral fracture followed 3 days later.(ABSTRACT TRUNCATED AT 250 WORDS)
Sold
M
M
Institut für Anaesthesiologie der Universität Würzburg.
Silber
R
R
Hopp
H
H
Meesmann
M
M
Ertl
G
G
D000328:Adult; D002815:Chordae Tendineae / Q000293:injuries* / Q000601:surgery; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000293:injuries / Q000601:surgery; D009104:Multiple Trauma / Q000601:surgery*; D010210:Papillary Muscles / Q000293:injuries* / Q000601:surgery; D012421:Rupture; D013898:Thoracic Injuries / Q000601:surgery*; D014949:Wounds, Nonpenetrating / Q000601:surgery*
Erfolgreiches Vorgehen bei Mitralklappenruptur mit Papillarmuskel- und Sehnenfadenausriss nach Mehrfachverletzung und stumpfem Thoraxtrauma.