The diagnosis of cardiac valve injury with major chest trauma is often delayed. An experience with four patients illustrates the clinical syndromes that may occur. Nonpenetrating blunt chest trauma produced the valve injury in three patients, and the fourth received a shotgun wound. Injury to the tricuspid valve was masked by the associated thoracic trauma in both patients with this lesion, but progressive deterioration led to successful valve replacement ten years and five months after injury. Rupture of the mitral valve produced progressive respiratory failure that was reversed by emergency valve replacement in the third patient.
The fourth patient has remained stable without operative treatment for acute aortic insufficiency resulting from the shotgun pellets.
At present, serial electrocardiography is the best diagnostic method for early detection of cardiac injury with nonpenetrating chest trauma.