Noninfectious Mitral Annular Disruption

A previously healthy 35-year-old man fell from a height of 25 meters while pruning a tree. His fall was somewhat slowed by the untrimmed tree branches. The ground impact focused on the right thorax and axilla, with resultant closed head injury, right clavicular fracture, and multiple right-sided rib fractures with pneumo- and hemothorax. Emergent tube thoracotomy, tracheotomy, and orthopedic interventions were conducted. The patient’s 10-day hospital course was notable for steady improvement, and, other than for a mild traumatic brain injury, he felt well on discharge. Prior to discharge, a loud holosystolic murmur, consistent with mitral regurgitation, was auscultated. The patient remained afebrile and there was no evidence of heart failure or systemic embolic phenomena. A transthoracic echocardiogram done during the admission was suggestive of severe mitral …