Traumatic Valvular Injury

PATHOLOGY AND CLINICAL PRESENTATION

Penetrating cardiac trauma can affect the right ventricle, the left ventricle, and the great vessels. Laceration of the cardiac valves with acute valvular regurgitation attributable to leaflet tear or chordae or papillary muscle rupture may also occur.

Nonpenetrating or blunt trauma often occur secondary to falls or motor vehicle accidents with deceleration injuries. Valve injury can occur in the aortic, mitral, or tricuspid position. In the aortic position, the most common lesion is aortic leaflet tear or detachment from the annulus, particularly the non–coronary leaflet. In the mitral and tricuspid positions, leaflet tear or leaflet prolapse secondary to papillary muscle or chordae rupture can be observed.

In most instances, patients present with acute severe valvular regurgitation and hemodynamic deterioration requiring early diagnosis and surgical treatment. Occasionally following blunt trauma, valvular regurgitation can be well tolerated initially and the diagnosis may be delayed. For this reason, the work-up should be comprehensive in the setting of trauma. Associated cardiac lesions should be carefully investigated (such as myocardial contusion, hemopericardium, or ventricular septal rupture) as well as thoracic injuries (such as lung injury), aortic isthmus rupture, or extrathoracic injuries.

TRAUMATIC MITRAL REGURGITATION

Traumatic mitral valve regurgitation can result from chordae rupture, leaflet tear or disruption, and papillary muscle rupture. Reconstructive techniques are particularly indicated for traumatic mitral valve lesions in young patients because of the feasibility of valve reconstruction in the majority of cases. Excellent long-term results from reconstruction can be expected if the valvular tissue is otherwise normal. The techniques described in Section II can be used, guided by the functional approach and the “one lesion one technique” principle. Chordae rupture and/or leaflet tear are the most frequent mechanisms of regurgitation. They can be corrected by using the techniques described in Chapters 10 and 11 of Section II. In the case of papillary muscle rupture, papillary muscle reimplantation is a viable option in selected patients.