Isolated tricuspid insufficiency. Report of a case with valve replacement

Chronic tricuspid regurgitation and bifascicular block due to blunt chest trauma

Closed-chest trauma in a young man was followed by rupture of a right ventricular papillary muscle and bifascicular block. This produced signs and symptoms of tricuspid regurgitation and recurrent syncope. Treatment by valve replacement and pacemaker implantation was successful. Review of 30 cases of traumatic tricuspid regurgitation reveals that this patient had characteristic findings: adult onset of isolated tricuspid regurgitation, a history of trauma, right bundle branch block, and cardiomegaly without signs of left ventricular failure. In addition, right atrial hypertension of longstanding may produce cyanosis because of right-left shunting through a patent foramen ovale.

Isolated tricuspid insufficiency

Isolated tricuspid insufficiency can be a well-tolerated lesion, as illustrated by a 32-year follow-up in one patient reported here. A second case of recent onset is also described. The 13 reported cases of isolated tricuspid insufficiency due to trauma can be divided into two groups: ruptured papillary muscle or ruptured chordae tendineae and/or valve. All patients with ruptured papillary muscle were dead or had surgery within 4 months after trauma. The earliest surgery in the chordae tendineae group was 1½ years after trauma. Physical findings in isolated tricuspid insufficiency are distinctive; the electrocardiogram usually shows incomplete right bundle-branch block, and the chest roentgenogram shows cardiomegaly. Indicator-dilution curves from the right atrium and pulmonary artery are useful for confirmation of the diagnosis. Surgery is indicated when papillary muscles are ruptured, but conservative treatment is probably usually indicated in the other patients.