Case Report

Latent Avulsion of the Posterior Mitral Leaflet Base from the Mitral Annulus Following a Motor Vehicle Accident: A Case Report


Injuries to the heart and great vessels should always be considered after blunt chest trauma. Valvular damage rarely occurs after blunt trauma, but symptoms may be delayed. A 58-year-old woman was referred to our hospital with exertional dyspnea (functional class III) and palpitations for elective transesophageal echocardiography. Her symptoms had exacerbated in the preceding 2 or 3 months. Physical examination showed holosystolic murmurs (IV/VI) at the lower sternal border with extension to the apex. Transesophageal echocardiography revealed avulsion of the base of the posterior mitral valve leaflet (P3) from the annulus. In the past medical history, there was a history of a motor vehicle accident 9 months earlier. The patient was recommended for mitral valve surgery. Mitral valve replacement was performed, and the diagnosis was confirmed by surgery. The patient was discharged without any complications.

1. Goetz W, Wahba A, Pandian NG, Birnbaum DE. Mitral valve incompetence following blunt chest trauma after mitral valve repair. Recognition by three-dimensional echocardiography. Scand Cardiovasc J 2001;35:221-222.
2. Hodge A, Forbus G, Hsia TY. Concomitant repair of mitral valve papillary muscle rupture and tricuspid valve avulsion in a pediatric patient after a motor vehicle collision. J Extra Corpor Technol 2009;41:180-182.
3. McCauley R, Shariff F, Steinberg M, Bemenderfer TB, Davis P, Thompson M, Lesh C, Walsh M, Evans E. Blunt thoracic trauma-induced mitral papillary muscle avulsion with pericardial rupture and cardiac herniation: difficult and delayed diagnoses. Case Rep Surg 2020;2020:3268253.
4. Pillai R, Fountain SW, Qureshi SA, Mitchell A, Rees A. Avulsion of the anterior papillary muscle of the mitral valve due to non-penetrating trauma to the chest. Thorax 1982;37:943-944.
5. Marchese N, Facciorusso A, Vigna C. Mitral perivalvular leak after blunt chest trauma: a rare cause of severe subacute mitral regurgitation. Tex Heart Inst J 2015;42:579-581.
6. Bernabeu E, Mestres CA, Loma-Osorio P, Josa M. Acute aortic and mitral valve regurgitation following blunt chest trauma. Interact Cardiovasc Thorac Surg 2004;3:198-200.
7. Farmery AD, Chambers PH, Banning AP. Delayed rupture of the mitral valve complicating blunt chest trauma. J Accid Emerg Med 1998;15:422-423.
8. McDonald ML, Orszulak TA, Bannon MP, Zietlow SP. Mitral valve injury after blunt chest trauma. Ann Thorac Surg 1996;61:1024-1029.
9. Armstrong WF. Mitral valve disease. In: Armstrong WF, Ryan T, eds. Feigenbaum’s Echocardiography. 8th ed, Philadelphia: Lippincott Williams & Wilkins; 2018. p. 53-107.
10. Kan CD, Yang YJ. Traumatic aortic and mitral valve injury following blunt chest injury with a variable clinical course. Heart 2005;91:568-570.
11. Ranganathan N, Burch GE. Gross morphology and arterial supply of the papillary muscles of the left ventricle of man. Am Heart J 1969;77:506-516.
12. Parmley LF, Manion WC, Mattingly TW. Nonpenetrating traumatic injury of the heart. Circulation 1958;18:371-396.
13. Liedtke A, DeMuth W. Nonpenetrating cardiac injuries: a collective review. Am Heart J 1973; 86:687-697.
14. Cuadros CL, Hutchinson JE, 3rd, Mogtader AH. Laceration of a mitral papillary muscle and the aortic root as a result of blunt trauma to the chest. Case report and review of the literature. J Thorac Cardiovasc Surg 1984;88:134-140.
15. Selzer A, Kelly JJ, Jr, Vannitamby M, Walker P, Gerbode F, Kerth WJ. The syndrome of mitral insufficiency due to isolated rupture of the chordae tendineae. Am J Med 1967;43:822-836.
16. Shimokawa T, Tomita S, Suda H, Yoshikai M, Minato N, Natsuaki M, Ito T. A case report of mitral valve plasty for traumatic mitral regurgitation. Kyobu Geka 1996;49:228-230.
17. Reardon MJ, Conklin LD, Letsou GV, Safi HJ, Espada R, Baldwin JC. Mitral valve injury from blunt trauma. J Heart Valve Dis 1998;7:467-470.
18. Kugai T, Chibana M. Rupture in a mitral papillary muscle following blunt chest trauma. Jpn J Thorac Cardiovasc Surg 2000;48:394-397.
19. Hendren WG, Nemec JJ, Lytle BW, Loop FD, Taylor PC, Stewart RW, Cosgrove DM, 3rd. Mitral valve repair for ischemic mitral insufficiency. Ann Thorac Surg 1991;52:1246-1251.
IssueVol 17 No 2 (2022): J Teh Univ Heart Ctr QRcode
SectionCase Report(s)
Mitral valve insufficiency Thoracic injuries Myocardial contusions

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Mohseni Badalabadi R, Siavosh P, Sadeghian H. Latent Avulsion of the Posterior Mitral Leaflet Base from the Mitral Annulus Following a Motor Vehicle Accident: A Case Report. J Tehran Heart Cent. 2022;17(2):78-81.