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Jacob A, Okafor DK, Bhattacharyya S, Wong K. Buying time! VA-ECMO as a bridge to successful reoperative cardiac surgery in a case of traumatic tricuspid valve injury. J Surg Case Rep 2023; 2023:rjad597. [PMID: 37936676 PMCID: PMC10627349 DOI: 10.1093/jscr/rjad597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/10/2023] [Indexed: 11/09/2023] Open
Abstract
Cardiac surgery performed on patients in cardiogenic shock is associated with a high mortality and morbidity. Preoperative Extra Corporeal Membrane Oxygenation (ECMO) in cardiogenic shock gives critically-ill patients a chance for surgical intervention and is associated with better surgical outcomes. We present a 29-year-old male who had a ventricular septal defect closure as a child and presented with multi-organ injuries following polytrauma. He was in cardiogenic shock despite maximal inotropic support. Transesophageal echocardiography demonstrated torrential tricuspid regurgitation (TR) from a flail tricuspid valve (TV) leaflet as the cause of cardiogenic shock. He was stabilized on Veno-Arterial ECMO and underwent reoperative cardiac surgery. Intra-operatively, the anterior leaflet of his TV and its papillary muscle was detached from the right ventricle. He had a successful tissue TV replacement. Early surgery was indicated to treat right ventricular failure due to torrential TR, but due to his restricting non-cardiac injuries, ECMO was successfully used as a short-term support strategy and as a bridge to definitive surgery.
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Affiliation(s)
- Abiah Jacob
- Barts Heart Centre, St.Bartholomew’s Hospital, West Smithfield, EC1A 7BE London, United Kingdom
| | - Donatus K Okafor
- Barts Heart Centre, St.Bartholomew’s Hospital, West Smithfield, EC1A 7BE London, United Kingdom
| | - Sanjeev Bhattacharyya
- Barts Heart Centre, St.Bartholomew’s Hospital, West Smithfield, EC1A 7BE London, United Kingdom
- University College London Hospital, 235 Euston Rd., NW1 2BU London, United Kingdom
| | - Kit Wong
- Barts Heart Centre, St.Bartholomew’s Hospital, West Smithfield, EC1A 7BE London, United Kingdom
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Longfellow E, Aberle C, Lamelas J, Fabbro M, Johnson E, Yu S, Augoustides JG, Fernando RJ. Traumatic Injury of the Tricuspid Valve-Navigating the Challenges in Diagnosis and Management. J Cardiothorac Vasc Anesth 2021; 36:906-914. [PMID: 34226110 DOI: 10.1053/j.jvca.2021.05.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 05/24/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Eric Longfellow
- Department of Anesthesiology, Perioperative Medicine, and Pain Management, Miller School of Medicine, University of Miami, Miami, FL
| | - Corinne Aberle
- Department of Cardiothoracic Surgery, Miller School of Medicine, University of Miami, Miami, FL
| | - Joseph Lamelas
- Department of Cardiothoracic Surgery, Miller School of Medicine, University of Miami, Miami, FL
| | - Michael Fabbro
- Department of Anesthesiology, Perioperative Medicine, and Pain Management, Miller School of Medicine, University of Miami, Miami, FL
| | - Eric Johnson
- Department of Anesthesiology, Perioperative Medicine, and Pain Management, Miller School of Medicine, University of Miami, Miami, FL
| | - Soojie Yu
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Scottsdale, AZ
| | - John G Augoustides
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rohesh J Fernando
- Division of Cardiothoracic Anesthesia, Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC.
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Lamela Domenech AE, Lopez-Menendez F, López-Candales A. Tricuspid Papillary Muscle Rupture Due to Blunt Chest Trauma. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:2733-2736. [PMID: 27872424 DOI: 10.7863/ultra.15.12058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
| | | | - Angel López-Candales
- Cardiovascular Medicine Division, University of Puerto Rico School of Medicine, Medical Sciences, Campus San Juan, Puerto Rico
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Oliemy A, Mahesh B, Pathi V. Acute Traumatic Right to Left Cardiac Shunt. Ann Thorac Surg 2016; 102:e303-4. [PMID: 26926097 DOI: 10.1016/j.athoracsur.2016.02.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 02/17/2016] [Accepted: 02/22/2016] [Indexed: 11/16/2022]
Abstract
Cardiac injuries after penetrating chest trauma are uncommon but potentially life threatening; these injuries can remain occult during the early stage because of the cardiac reserve of youthful physiology and may present at a later stage as the initial damage progresses or compensatory mechanisms fail. We report a case of unusual penetrating cardiac trauma from a posterior intercostal stab wound that affected both the interatrial septum and the tricuspid valve, leading to a stormy presentation as a result of the development of an acute right-to-left shunt followed by a successful surgical repair.
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Affiliation(s)
- Ahmed Oliemy
- Cardiac Surgery and Transplant Department, Golden Jubilee National Hospital, Glasgow, United Kingdom.
| | - Balakrishnan Mahesh
- Cardiac Surgery and Transplant Department, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Vivek Pathi
- Cardiac Surgery and Transplant Department, Golden Jubilee National Hospital, Glasgow, United Kingdom
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Abstract
Anatomy of the native cardiac valves, reasons for surgical excision and examination, and a summary of the gross examination and documentation are presented. Aortic stenosis, aortic valve regurgitation, tricuspid and pulmonary valve pathology, mitral stenosis, and mitral insufficiency are each presented with an overview, focused anatomy, and discussion of pathologic diagnosis by gross examination and histology.
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Doi A, Takahara Y, Mogi K, Hatakeyama M. Repair of traumatic tricuspid regurgitation by bicuspidization. Gen Thorac Cardiovasc Surg 2007; 55:499-501. [PMID: 18066641 DOI: 10.1007/s11748-007-0171-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2007] [Accepted: 08/14/2007] [Indexed: 11/29/2022]
Abstract
Traumatic tricuspid regurgitation is a fairly rare complication following blunt chest trauma but not as uncommon as it was believed to be before the advent of transthoracic echocardiography. We report a case of severe tricuspid regurgitation with ruptured chordae tendineae 10 years after blunt chest trauma that was successfully repaired with a simple method. The operative technique consisted of plication of the anteroposterior commissure to create a bicuspid valve, along with ring annuloplasty.
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Affiliation(s)
- Atsuo Doi
- Division of Cardiovascular Surgery, Funabashi Municipal Medical Center, 1-21-1, Kanasugi, Funabashi, Chiba, 273-8588, Japan.
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Moreno R, Zamorano J, Ortega A, Villate A, Almería C, Herrera D, Rodrigo JL, Morales R, Sánchez-Harguindey L. Tricuspid valve chordae rupture following pacemaker electrode replacement. Int J Cardiol 2003; 87:291-2. [PMID: 12559554 DOI: 10.1016/s0167-5273(02)00313-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Reiss J, Razzouk AJ, Kiev J, Bansal R, Bailey LL. Concomitant Traumatic Coronary Artery and Tricuspid Valve Injury: A Heterogeneous Presentation. ACTA ACUST UNITED AC 2001; 50:942-4. [PMID: 11371859 DOI: 10.1097/00005373-200105000-00031] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Blunt thoracic trauma resulting in both tricuspid valve rupture and coronary artery injury is uncommon, encompasses a large spectrum of presentations and, therefore, can be difficult to diagnose. This report illustrates the heterogeneous presentation and clinical course of two patients with such a combination of cardiac injuries. The patient with associated right coronary artery dissection developed progressive right ventricular failure over a 12-year period before successful surgical repair, whereas another patient with left anterior descending coronary artery thrombosis required urgent operation for acute right ventricular dysfunction and hemodynamic decompensation.
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Affiliation(s)
- J Reiss
- Departments of Cardiothoracic Surgery and Cardiology, Loma Linda University Medical Center, 11175 Campus Street, Loma Linda, CA 92354, USA
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dos Santos J, de Marchi CH, Bestetti RB, Corbucci HA, Pavarino PR. Ruptured chordae tendineae of the posterior leaflet of the tricuspid valve as a cause of tricuspid regurgitation following blunt chest trauma. Cardiovasc Pathol 2001; 10:97-8. [PMID: 11425604 DOI: 10.1016/s1054-8807(01)00059-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
A 12-year-old boy suffered a blunt chest trauma. Some hours later, a pulsatile bilateral jugular venous distension, a holosystolic murmur heard at the low parasternal border and hepatomegaly were observed. On echocardiography, ruptured chordae tendineae of the posterior leaflet of the tricuspid valve, as well as tricuspid regurgitation were detected. He remained asymptomatic during hospital stay and was discharged home in good condition. Thus, isolated ruptured chordae tendineae of the posterior leaflet of the tricuspid valve is another cause of tricuspid regurgitation following blunt chest trauma.
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Affiliation(s)
- J dos Santos
- Division of Cardiology, Faculty of Medicine of São José do Rio Preto, São José do Rio Preto, Brazil
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10
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Abstract
Blunt traumatic rupture of the tricuspid valve is exceedingly uncommon, and injury of the tricuspid valve due to penetrating trauma appears to be even more rare. Presented here is a case of tricuspid valve injury due to penetrating cardiac trauma repaired by leaflet resuspension 17 years later.
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Affiliation(s)
- J W Bolton
- Department of Cardiothoracic Surgery, Wilford Hall USAF Medical Center, Lackland Air Force Base, Texas 78236-5300, USA
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12
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Janzing HM, Rommens P, Flameng W, Aerts R, Lauwers P, Broos P. Severe liver rupture and tricuspid valve rupture in a patient with multiple trauma. THE JOURNAL OF TRAUMA 1995; 38:828-9. [PMID: 7760422 DOI: 10.1097/00005373-199505000-00031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A patient with a severe liver injury and an acute cardiac failure due to a traumatic tricuspid valve failure is presented. During liver surgery, massive venous bleeding was caused by regurgitation of blood through the insufficient tricuspid valve. Right ventricular failure, leading to persistent hemodynamic instability, and caused by massive posttraumatic tricuspid regurgitation, has been treated with biological valve replacement. Diagnosis and management of posttraumatic tricuspid insufficiency are discussed.
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Affiliation(s)
- H M Janzing
- Department of Traumatology and Emergency Surgery, University Hospitals, Catholic University of Leuven, Belgium
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