[A case of mitral regurgitation from non-penetrating chest trauma]

An 18-year-old boy, with no evidence of cardiac murmurs in the past, was admitted to our hospital after steering wheel injury on Nov 22, 1987. He immediately became in shock state. Physical examination revealed a grade 3/6 apical holosystelic murmur and moist rales in lungs. Two-dimensional echocardiography showed a prolapsed anterior leaflet and a lot of pericardial effusion. He recovered soon after subxiphoid pericardiotomy, then we obtained bloody fluid of 200 microliters. In cardiac catheterization study, the pulmonary artery wedge pressure was elevated with a V-wave of 31 mmHg. Coronary angiogram, right ventriculogram, and aortogram were normal, but left ventriculography revealed grade 4 (Seller's) mitral regurgitation. Mitral valve replacement was performed with a Bjork-Shiley prosthesis on Feb 8, 1988. Anterior papillary muscle was in a white necrosis, but not ruptured. Mitral valve leaflets and chordae tendineae were intact. 12 cases of mitral regurgitation from non-penetrating blunt chest trauma were reported in Japan, but we first report a case of mitral regurgitation due to non-ruptured papillary muscle dysfunction.