Traumatic tricuspid insufficiency

Traumatic tricuspid insufficiency: a case report with a review of the literature

Traumatic tricuspid insufficiency, a rare complication of blunt chest trauma, has been reported with increasing frequency during the last 40 years. Automobile accidents are the leading cause of traumatic tricuspid valve regurgitation. The most frequently reported injury is chordal rupture, followed by rupture of the anterior papillary muscle and leaflet tear, primarily of the anterior leaflet. In the acute phase of the injury, the traumatic lesion may go undetected. In the chronic phase many patients remain asymptomatic and others exhibit symptoms and signs of moderate to severe right heart failure. Clinically overt right heart failure has been the traditional indication for surgery, which usually consisted of tricuspid valve replacement. More recently, a more aggressive strategy, with surgical repair of the valve performed before deterioration of the right ventricular function occurs, has been advocated.

Traumatic tricuspid insufficiency--a case report

Traumatic tricuspid insufficiency following blunt chest trauma, although an uncommon entity, has been reported more frequently over the past 2 decades. Increased physician awareness of the possibility of myocardial trauma accompanied by proper clinical evaluation and follow-up are the keys to a successful outcome regardless of whether a medical or surgical approach to treatment is initially selected. Early surgical correction has become the preferred treatment in most instances and may be influenced by clinical status and other associated comorbid conditions. A patient with a combination of myocardial contusion, valve laceration, and papillary muscle rupture is presented.

Blunt cardiac injury and intraoperative hypoxaemia

A 28-yr-old man sustained blunt chest trauma in a motor vehicle accident. Severe intraoperative hypoxaemia occurred, unresponsive to oxygen and positive expiratory pressure therapy. Trans-oesophageal echocardiography revealed myocardial contusion and tricuspid valve rupture. Dobutamine improved left ventricular function and ejection fraction resulting in an immediate improvement in arterial oxygenation and saturation. Tricuspid injury and the diagnosis of myocardial contusion are discussed. The case highlights the importance of a non-pulmonary mechanism of hypoxaemia.

Tricuspid valve regurgitation following blunt thoracic trauma

Valvular lesions following blunt thoracic trauma are uncommon. Tricuspid valve regurgitation occurs very rarely. We report a successful tricuspid valve reconstruction for rupture of the chordae tendineae in a young man nine years after a motor vehicle accident. The value of echocardiography and transesophageal echocardiography for the diagnosis and quantification of this valve lesion is stressed.

Tricuspid valve incompetence caused by nonpenetrating thoracic trauma

Tricuspid valve incompetence from ruptured papillary muscle or chordae as a result of nonpenetrating trauma is uncommon. Blunt trauma causing partial detachment of a leaflet from the annulus is very rare. We report the case of a young adult involved in a car accident who had these findings. Operative repair with resuture of the leaflet to the annulus and annuloplasty using a Carpentier ring resulted in complete recovery.

Repair of flail anterior leaflets of tricuspid and mitral valves by cusp remodeling

We present an alternative approach to extensive rupture of the chordae tendineae leading to flail anterior leaflets. Resection of the affected cusp segment, suture of the cut edges, and extensive plication of the segment of annulus devoid of leaflets abolished massive regurgitation while maintaining an adequate valve orifice.

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.

Acquired cyanotic heart disease secondary to traumatic tricuspid regurgitation. Case report with a review of the literature

A case of traumatic tricuspid insufficiency leading to right atrial enlargement and to a patent foramen ovale with right to left shunting is presented. Six similar cases previously reported are reviewed. The time course of clinical deterioration was related to the type of tricuspid valve damage incurred. Papillary muscle rupture led to surgery within a year, whereas less severe chordal damage allowed a more benign course that lasted from 10 to 25 years from the time of injury to the time of surgery. Surgical repair of the incompetent tricuspid valve and closure of the atrial septal defect led to significant improvement. The diagnostic usefulness of radionuclide imaging and echocardiography is demonstrated in this case. A mechanism of right to left interatrial shunting in the presence of normal pulmonary arterial pressures is proposed; this invokes phasic increases in right atrial pressure from tricuspid insufficiency and streaming of blood from the inferior vena cava into the left atrium across a patent foramen ovale in a manner that resembles conditions in the fetal circulation.

Traumatic tricuspid regurgitation. Long-term survival

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