Valvular injuries are also rare but have been reported in the literature. Aortic and mitral valves are the most commonly affected, followed by tricuspid and pulmonic valves, because the mural pressure is higher on the left side of the heart [54]. Valvular injuries can present as perivalvular leak, dehiscence because of papillary muscle or chordae tendineae rupture, tearing of valve leaflets, or papillary muscle contusion leading to necrosis. Aortic and pulmonic valves are vulnerable to injury during early diastole and atrioventricular valves are prone to injury during early systole when the intraventricular pressure is increased [7]. All valvular injuries present with signs and symptoms of regurgitation, therefore, it is prudent to perform echocardiography and assess the severity of regurgitation to guide further management with surgical repair in severe cases. Several case reports describe posttraumatic severe mitral regurgitation requiring surgical repair following MVAs [55-57]. A few case reports have described the use of echocardiography for diagnosing wall motion abnormality in the setting of myocardial infarction and coronary artery dissection after blunt chest trauma, especially when myocardial contusion mimics myocardial infarction with elevated cardiac troponins [42,58]. Prompt identification of wall motion abnormality in coronary artery distribution following blunt chest trauma is important for the identification and treatment of coronary artery dissection. Additionally, when a wall motion abnormality is present in the absence of elevated high-sensitivity cardiac troponins, a diagnosis of myocardial concussion can be made. Myocardial concussion does not cause myocardial anatomic injuries that lead to necrosis and elevated high-sensitivity cardiac troponins but instead stretches the cell membrane, leading to activation of ion channels through mechanical- electrical coupling that trigger ventricular arrhythmias [59].
Blunt Chest Trauma Suspected Cardiac Injury. Valvular injuries are also rare but have been reported in the literature. Aortic and mitral valves are the most commonly affected, followed by tricuspid and pulmonic valves, because the mural pressure is higher on the left side of the heart [54]. Valvular injuries can present as perivalvular leak, dehiscence because of papillary muscle or chordae tendineae rupture, tearing of valve leaflets, or papillary muscle contusion leading to necrosis. Aortic and pulmonic valves are vulnerable to injury during early diastole and atrioventricular valves are prone to injury during early systole when the intraventricular pressure is increased [7]. All valvular injuries present with signs and symptoms of regurgitation, therefore, it is prudent to perform echocardiography and assess the severity of regurgitation to guide further management with surgical repair in severe cases. Several case reports describe posttraumatic severe mitral regurgitation requiring surgical repair following MVAs [55-57]. A few case reports have described the use of echocardiography for diagnosing wall motion abnormality in the setting of myocardial infarction and coronary artery dissection after blunt chest trauma, especially when myocardial contusion mimics myocardial infarction with elevated cardiac troponins [42,58]. Prompt identification of wall motion abnormality in coronary artery distribution following blunt chest trauma is important for the identification and treatment of coronary artery dissection. Additionally, when a wall motion abnormality is present in the absence of elevated high-sensitivity cardiac troponins, a diagnosis of myocardial concussion can be made. Myocardial concussion does not cause myocardial anatomic injuries that lead to necrosis and elevated high-sensitivity cardiac troponins but instead stretches the cell membrane, leading to activation of ion channels through mechanical- electrical coupling that trigger ventricular arrhythmias [59].