[Unexplained circulatory collapse after a motorcycle accident].
BACKGROUND
Cardiac valve injury caused by non-penetrating chest trauma is unusual but may occur even after moderate injuries.


METHODS
A 19-year-old man sustained blunt trauma to the chest and abdomen in a motorcycle crash. He was able to walk, removed his jacket and helmet and called for help via his mobile phone. He had bilateral lung contusions and multiple rib fractures. A rupture of the spleen was managed conservatively. On day 4 he needed mechanical ventilatory support and a left chest tube was inserted. Transthoracic echocardiography showed a mitral valve insufficiency grade 3 of 4, increased pulmonary artery systolic pressure of 50 mm Hg, tricuspidal insufficiency and moderate amounts of pericardial fluid. His situation deteriorated on day 12. Pulmonary catheter measurements led to decrease of noradrenaline infusion and increase in cardiac output, but his symptoms of pericardial tamponade worsened.


RESULTS
Open-heart surgery was performed. Pericardial fluid under pressure was evacuated and because of a malfunctioning white elongated anterior papillary muscle, a 27 mm mechanical mitral valve was inserted. He recovered uneventfully.


CONCLUSIONS
A low threshold for echocardiography in these cases is advocated. Earlier use of a pulmonary catheter could have optimised treatment and time of surgery.
Kalstad
Jonne
J
Anestesi og intensivavdelingen, Nordlandssykehuset, 8092 Bodø.
Sandvik
Johan
J
Myrmel
Truls
T
Bjørsvik
Geir
G
Nielsen
Erik Waage
EW
D000063:Accidents, Traffic; D000328:Adult; D004562:Electrocardiography; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology; D006335:Heart Injuries / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000293:injuries* / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology; D009049:Motorcycles; D012769:Shock / Q000209:etiology*; D014463:Ultrasonography; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000209:etiology