Heterogeneity of traumatic injury of the tricuspid valve: A report of four cases

Early myocardial damage (EMD) and valvular insufficiency result in impaired cardiac function after multiple trauma in pigs

One third of multiple trauma patients present abnormal echocardiographic (ECHO) findings. Therefore, ECHO diagnostic after trauma is indicated in case of hemodynamic instability, shock, after chest trauma and after cardiac arrest. 20 male pigs underwent multiple trauma. Blood samples were collected 4 and 6 h after trauma and concentrations of heart-type fatty acid binding protein (HFABP) as a biomarker for EMD were measured. Myocardial damage was evaluated by scoring Hematoxylin–Eosin stained sections. At baseline, 3 and 6 h after trauma, transesophageal ECHO (TOE) was performed, invasive arterial and left ventricular blood pressure were measured to evaluate the cardiac function after multiple trauma. Systemic HFABP concentrations were elevated, furthermore heart injury score in multiple trauma animals was increased determining EMD. A significant decrease of blood pressure in combination with a consecutive rise of heart frequency was observed. Ongoing depression of mean arterial pressure and diastolic blood pressure were accompanied by changes in ECHO-parameters indicating diastolic and systolic dysfunction. Furthermore, a valvular dysfunction was detected. In this study complex myocardial and valvular impairment after multiple trauma in pigs has been observed. Therefore, detection of EMD and progressive valvular dysfunction might be crucial and therapeutically relevant.

Aversion for Avulsion: A Case of Delayed Diagnosis of Traumatic Tricuspid Rupture

Tricuspid rupture secondary to blunt force trauma is a rare diagnosis. However, the incidence of this injury is rising due to the improved initial treatment of complex trauma patients as well as enhanced early detection methods through the use of cardiac ultrasound. We report the case of an otherwise healthy 42 year old male who sustained significant blunt force trauma after a single motor vehicle accident. The diagnosis of traumatic papillary rupture and disruption of the valve apparatus was made on the day of admission after perioperative hemodynamic compromise and the use of intraoperative transesophageal echocardiography. However, treatment was delayed due to concerns of systemic anticoagulation leading to his eventual demise.

A case of traumatic tricuspid regurgitation caused by multiple papillary muscle rupture

Traumatic tricuspid regurgitation is a rare complication of blunt chest trauma. With the increase in the number of automobile accidents, traumatic tricuspid regurgitation has become an important problem after blunt chest trauma. It has been reported more frequently because of better diagnostic procedures and a better understanding of the pathology. The early diagnosis of traumatic tricuspid regurgitation is important because traumatic tricuspid injury could be effectively corrected with reparative techniques, early operation is considered to relieve symptoms and to prevent right ventricular dysfunction. Echocardiography can reveal the cause and severity of regurgitation. We experienced a case of tricuspid regurgitation after blunt chest trauma early diagnosis and valve repair were performed. This case reminds the physicians in the emergency department should be aware of this potential complication following non-penetrating chest trauma and echocardiography is useful and should play an early role.