Mitral valve repair surgery for traumatic rupture of the anterolateral papillary muscle.

We report a case of acute mitral insufficiency due to anterolateral papillary muscle rupture secondary to chest trauma. In our case, mitral valve repair was performed as an alternative to valve replacement, with good results during the immediate postoperative period and follow-up. The patient was a 41-year-old man with nothing remarkable in his medical history. He presented with high-energy frontal and lateral polytrauma and chest trauma, without central nervous system involvement, following a traffic accident. As a consequence of the trauma, he had several fractured ribs and bilateral pneumothorax (tension pneumothorax on the left side) and, thus, pleural drainage catheters were inserted. He also presented with pneumomediastinum, subcutaneous emphysema, and areas of pulmonary contusion, with no other apparent chest injuries. A few hours after admission, he exhibited radiological signs of acute pulmonary edema, which required orotracheal intubation and mechanical ventilation. Among the signs, we detected the development of a systolic cooing murmur (grade 3/6 over the mitral valve area), radiating toward the axilla. The electrocardiogram was normal. Transthoracic echocardiography was performed, revealing severe mitral regurgitation due to rupture of the head of the anterolateral papillary muscle, which provoked the complete prolapse of the P1 scallop (posterior leaflet) and A1 scallop (anterior leaflet), with eversion of the anterolateral commissure toward the left atrium (Figure 1). With a diagnosis of acute pulmonary edema caused by mitral regurgitation secondary to traumatic rupture of the anterolateral papillary muscle, the decision was made to treat the patient surgically. The intraoperative macroscopic findings were severe inferoposterior