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A 49 Age - year Age - old Age man Sex , with no History history History of History cardiac History disease History , presented Clinical_event with progressive Detailed_description dyspnea Sign_symptom of one Duration month's Duration duration Duration .
Medical History.
His medical history included blunt Detailed_description chest Biological_structure trauma Disease_disorder , the History result History of History an History accidental Activity fall Activity from History scaffolding History 15 Date months Date earlier Date .
He History had History fallen History approximately History 8 History feet History and History had History landed History on History the History right History side History of History his History back History and History on History his History right History shoulder History .
The patient had sustained bilateral Detailed_description pneumothorax Sign_symptom , right Biological_structure iliopsoas Biological_structure muscle Biological_structure hematoma Sign_symptom , multiple Detailed_description right Biological_structure costal Biological_structure fractures Sign_symptom , fracture Sign_symptom of the L3 Biological_structure vertebral Biological_structure body Biological_structure and the transverse Biological_structure process Biological_structure , and displaced Detailed_description fractures Sign_symptom of the right Biological_structure clavicle Biological_structure .
That hospitalization Clinical_event had lasted 40 Duration days Duration , during which time the clinicians had not detected any murmur Sign_symptom or requested a cardiac Diagnostic_procedure evaluation Diagnostic_procedure .
The patient returned to normal Activity activities Activity 4 Date weeks Date after Date discharge Clinical_event from the hospital Nonbiological_location and remained asymptomatic Sign_symptom for one Duration year Duration .
Upon his arrival Clinical_event at our department Nonbiological_location , auscultation Diagnostic_procedure revealed bibasilar Detailed_description rales Sign_symptom and a pansystolic Detailed_description murmur Sign_symptom .
Chest Biological_structure radiography Diagnostic_procedure showed mild Severity lung Biological_structure congestion Sign_symptom ; and transthoracic Biological_structure echocardiography Diagnostic_procedure , limited Detailed_description by Detailed_description suboptimal Detailed_description acoustic Detailed_description windows Detailed_description , revealed severe Severity , eccentric Detailed_description mitral Sign_symptom regurgitation Sign_symptom .
The valvular Biological_structure and subvalvular Biological_structure apparatus Biological_structure appeared to be structurally Sign_symptom normal Sign_symptom , and the left Biological_structure atrium Biological_structure was only mildly Severity dilated Sign_symptom .
The patient was treated with intravenous Administration diuretics Medication until the signs Sign_symptom and Sign_symptom symptoms Sign_symptom of Sign_symptom congestion Sign_symptom were relieved.
Coronary Biological_structure angiography Diagnostic_procedure revealed an absence of substantial coronary Disease_disorder disease Disease_disorder .
We therefore planned Clinical_event an elective surgical procedure for mitral Therapeutic_procedure valve Therapeutic_procedure repair Therapeutic_procedure .
Surgical Procedure.
During intraoperative Detailed_description transesophageal Diagnostic_procedure echocardiography Diagnostic_procedure ( TEE Diagnostic_procedure ), we observed both a trivial Severity central Detailed_description mitral Sign_symptom regurgitant Sign_symptom jet Sign_symptom and a severe Severity perivalvular Sign_symptom regurgitant Sign_symptom jet Sign_symptom , this last originating from a ventriculoatrial Biological_structure fistulous Sign_symptom communication Sign_symptom behind Biological_structure the Biological_structure P1 Biological_structure scallop Biological_structure (Fig.1).
Further examination confirmed the absence of structural Disease_disorder disease Disease_disorder involving the mitral Biological_structure leaflets Biological_structure or subvalvular Biological_structure apparatus Biological_structure .
After surgical Therapeutic_procedure exposure Therapeutic_procedure of the mitral Biological_structure valve Biological_structure , a small Lab_value tear Sign_symptom ( length, Distance 6–7 mm Distance ) could be seen behind Biological_structure the Biological_structure posterior Biological_structure leaflet Biological_structure , in a lateral Detailed_description position Detailed_description , involving also the annulus Biological_structure and the left Biological_structure atrial Biological_structure wall Biological_structure .
The absence of leaflet Biological_structure abnormalities Sign_symptom or vegetations Sign_symptom suggested the posttraumatic Detailed_description origin Detailed_description of the perivalvular Sign_symptom leak Sign_symptom .
Valvular Therapeutic_procedure repair Therapeutic_procedure was successfully achieved by direct suture Therapeutic_procedure of the tear with three Detailed_description 5 Detailed_description - 0 Detailed_description Prolene Detailed_description stitches Therapeutic_procedure and by the subsequent insertion of a 30 Distance - mm Distance mitral Therapeutic_procedure annuloplasty Therapeutic_procedure ring Therapeutic_procedure .
The patient was extubated Therapeutic_procedure the next day and his postsurgical Therapeutic_procedure course Therapeutic_procedure was uncomplicated Lab_value .
One Date year Date later Date , he was asymptomatic Sign_symptom , and his one-year follow Clinical_event - up Clinical_event transthoracic Biological_structure echocardiogram Diagnostic_procedure confirmed Lab_value the Lab_value excellent Lab_value result Lab_value of his surgical treatment.