A surgical case of severe tricuspid and mitral valvular regurgitation caused by a blunt chest trauma

: A 58-year-old male was transferred to our emergency unit 4 hours after he fell off the 5 meter-high steps onto the hard ground and had his left-side chest hit. On admission, he was in cardiogenic shock with the systolic blood pressure of 70 mmHg. There were no apparent open wounds. Echocardiography and ventriculography showed severe regurgitation of both atrioventricular valves, and signs of papillary muscular rupture were acknowledged in both ventricles. The low blood pressure along with acute pulmonary edema rapidly deteriorated so that an emergency surgical operation was needed on the same day of admission. Macroscopic observation at the operation showed transmural hematoma formation of the apex with ruptured anterior papillary muscles, with resultant incompetence of the anterior leaflets of both tricuspid and mitral valves. Judging from the severity of destruction of submitral and subtricuspid apparatuses, we performed replacement of both valves, not considering reconstructive procedures. Postoperative course was smooth, and he has led an active life for a follow up of 4 months. The complete papillary muscular rupture of both tricuspid and mitral valves at the same time has rarely been reported, and this case we experienced seems to be deserving of a report.