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Background
Contusio cordis after blunt chest trauma can be asymptomatic; however, severe complications can occur, immediately or with some delay. That is why patients after a blunt chest trauma should be clinically examined for cardiac involvement, allowing a timely recognition of serious complications and starting off adequate treatment.
Case 1 presentation
A 75-year-old man, blind but otherwise healthy, presented with progressive dyspnoea at the emergency ward. For the past few months he had experienced mild fatigue on exertion. Five days before presentation he fell on a pole with his chest. Thereafter, he experienced a marked increase in dyspnoea on light exertion.
Investigations
On initial physical examination, he was haemodynamically stable. His jugular veins were distended, bilateral pulmonary rales and a systolic murmur grade III/VI, punctum maximum at the apex was heard. His ECG showed sinus rhythm, with minor repolarisation disturbances. His chest X-ray showed signs of pulmonary oedema and a normal heart configuration. Laboratory results showed a normal troponin level. Transthoracic echocardiography showed a hyperdynamic left ventricle with severe mitral valve regurgitation with flail leaflet of the posterior mitral valve leaflet (PMVL) due to chordal rupture. Additional images were acquired by transoesophageal echocardiography confirming the diagnosis of a P2 chordal rupture ( figures 1 - 3 and videos 1 - 3 ).
Video 1 Transoesophageal echocardiography showing severe mitral regurgitation with flail posterior mitral valve leaflet due to chordal rupture. media-1 bcr-2014-204139.v1 10.1136/bcr-2014-204139v1
Video 2 Transoesophageal echocardiography showing flail leaflet of the posterior mitral valve leaflet. media-2 bcr-2014-204139.v2 10.1136/bcr-2014-204139v2
Video 3 Transoesophageal echocardiography with Doppler mode showing severe eccentric mitral regurgitation. media-3 bcr-2014-204139.v3 10.1136/bcr-2014-204139v3
Treatment
After admission, the clinical situation quickly deteriorated with acute heart failure. He required treatment with intravenous vasodilation, diuretics and oxygen, after which he stabilised. Coronary angiography revealed no significant coronary artery disease. One week later, successful mitral valve reconstruction was performed with a rectangular resection of the P2 scallop and an annuloplasty ring.
Outcome and follow-up
His recovery was without any problems. Six weeks after surgery medication could be discontinued.
Case 2 presentation
A 25-year-old woman presented to the emergency department after a frontal collision on a motorcycle with another motorcyclist. The patient was otherwise healthy.
Investigations
On primary survey, she was haemodynamically stable, but had an O2...