“二尖瓣低语”:1例老年农民外伤性二尖瓣返流的延迟诊断。

IF 0.8 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS
European Heart Journal: Case Reports Pub Date : 2025-08-16 eCollection Date: 2025-09-01 DOI:10.1093/ehjcr/ytaf399
Shinnosuke Tsukamoto, Kensuke Matsumoto, Tomohiro Hayashi, Akitaka Yamada, Satoru Kawasaki
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引用次数: 0

摘要

背景:外伤性二尖瓣反流(MR)是一种非常罕见的与钝性胸部创伤相关的并发症,特别是在相对低冲击损伤之后。在危急和混乱的情况下,多发创伤的诊断往往被延误,很容易被忽视。这种疏忽可能导致进行性血流动力学恶化,并最终导致致命的后果。病例总结:一名73岁男子在从卡车床上跌落2.5米后遭受钝性胸部创伤。初步评估显示左侧血气胸和多处肋骨骨折,未见心脏杂音或血流动力学受损的迹象。插入胸腔引流管,保守治疗后出院。然而,损伤后3周,新发现III级收缩期反流性杂音。经胸和经食管超声心动图显示严重偏心MR由于二尖瓣后脱垂引起的脊索断裂。术中检查证实P2脊索断裂伴黏液瘤变性。患者接受了成功的二尖瓣修复,术后恢复顺利。讨论:本病例强调了创伤性MR,虽然极其罕见,但即使在相对较小的创伤后也可能发生在老年人身上,可能是由于潜在的退行性改变。急性MR的临床症状可能被共存的损伤所掩盖,听诊结果可能只有在这些情况得到治疗后才会变得明显。虽然超声心动图对识别外伤性瓣膜功能障碍至关重要,但其有效性可能受到多重创伤相关因素的限制。因此,在钝性胸部创伤病例中,高度的怀疑是必不可少的,以防止忽视这种潜在的危及生命的并发症。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
'Whisper from the mitral valve': delayed diagnosis of traumatic mitral valve regurgitation in an elderly farmer-a case report.

Background: Traumatic mitral regurgitation (MR) is an exceptionally rare complication associated with blunt chest trauma, particularly following relatively low-impact injuries. In the critical and chaotic settings of polytrauma, its diagnosis is often delayed and can easily be overlooked. This oversight can lead to progressive haemodynamic deterioration and, ultimately, fatal outcomes.

Case summary: A 73-year-old man sustained blunt chest trauma after falling ∼2.5 m from a truck bed. Initial assessment revealed a left haemopneumothorax and multiple rib fractures, with no audible heart murmur or signs of haemodynamic compromise. A chest drain was inserted, and he was discharged after conservative management. However, 3 weeks post-injury, a Grade III systolic regurgitant murmur was newly detected. Transthoracic and transoesophageal echocardiography revealed severe eccentric MR due to posterior mitral valve prolapse caused by chordal rupture. Intraoperative inspection confirmed a P2 chordal rupture with myxomatous degeneration. The patient underwent successful mitral valve repair and had an uneventful postoperative recovery.

Discussion: This case highlights that traumatic MR, though extremely rare, can occur even after relatively minor trauma in elderly individuals, potentially due to underlying degenerative changes. Clinical signs of acute MR can be obscured by coexisting injuries, and auscultatory findings may only become apparent after these conditions have been treated. While echocardiography is crucial for identifying traumatic valvular dysfunction, its effectiveness can be limited by various factors associated with polytrauma. Therefore, a high index of suspicion is essential to prevent overlooking this potentially life-threatening complication in cases of blunt chest trauma.

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来源期刊
European Heart Journal: Case Reports
European Heart Journal: Case Reports Medicine-Cardiology and Cardiovascular Medicine
CiteScore
1.30
自引率
10.00%
发文量
451
审稿时长
14 weeks
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