Acute mitral regurgitation caused by penetrating chest injury

A 22-year-old male patient with penetrating cardiac injury was admitted to general surgery, where he underwent an immediate, life saving operation. Subsequent cardiological evaluation established the presence of a well tolerated mitral regurgitation without the need for urgent cardiac surgical intervention. One month later the patient was re-admitted in cardiac failure. Transesophageal echocardiography suggested the detachment of the posterior leaflet, which was not previously demonstrated by transthoracic echocardiography. Emergency surgery confirmed the diagnosis and the mitral valve was successfully repaired. The postoperative course was uneventful. This case history suggests that transesophageal echocardiography is mandatory after penetrating cardiac injury even in the case of good clinical condition and negative transthoracic echocardiographic findings. In the presence of valvular injury, early surgical intervention is recommended.