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Papillary Muscle Rupture of the Mitral Valve Following Blunt Thoracic Trauma
Zaheer Faizi1, Sirivan Seng1, Jaime Simone2, Asanthi Ratnasekera1, Charles Geller1.
1Crozer Chester Medical Center, Upland, PA, USA, 2Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA.

OBJECTIVE: Blunt cardiac injury may be caused by large deceleration forces seen in motor vehicle accidents and can range from non-life threatening arrhythmias to potentially fatal cardiac conditions such as valve disruption.
METHODS: A 28-year-old unrestrained male presented following a high speed motor vehicle accident involving direct blunt-force chest trauma. After two days in the trauma intensive care unit, he developed persistent hypoxemia with frothy pink sputum despite multiple modes of mechanical ventilation. Transesophageal echocardiography (TEE) ultimately revealed severe mitral regurgitation due to papillary muscle disruption. Diagnosis was delayed due to concomitant chest pathology.
RESULTS: Rupture was discovered on transesophageal echo after multiple modalities for his persistent hypoxemia were ruled out. The patient underwent bronchoscopy and CT angiography. Anterolateral papillary muscle rupture was noted on TEE prior to ECMO initiation. After stabilization, a bileaflet mechanical mitral valve was placed. The patient achieved a complete recovery.
CONCLUSIONS: Diagnosis of cardiac valvular injuries may be difficult due to concomitant injuries in a trauma patient. Though rare, papillary muscle rupture should be included in the differential diagnosis following blunt thoracic trauma particularly involving persistent hypoxemia that is resistant to prone positioning and multiple ventilation modes including airway pressure release ventilation.


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