Rupture of the tricuspid valve due to smashing the chest into the steering wheel

EFFECT OF STEERING WHEEL HEIGHT AND INCLINATION ANGLE ON BLUNT CARDIAC INJURY DURING THE THORAX-TO-STEERING WHEEL IMPACT

Blunt cardiac injury (BCI) in the traffic accidents usually causes serious consequences like heart failure or even death, and the impact of steering wheel to the thorax is one of the main causes of blunt heart injury. Therefore, more realistic heart models are needed to predict the biomechanical response and related injury of the heart during a thorax-to-steering wheel impact. This study developed three-dimensional finite element (FE) models of lungs, aorta and heart, and validated the models through published cadaver tests by comparing the contact force and intracardiac pressures in four heart chambers. Then, various simulations of thorax-to-steering wheel impact were carried out at different impact heights (lower, middle and higher) and different inclination angles of steering wheel (15∘, 30∘, 45∘ and 60∘) to investigate the effects of impact height and inclination angle on heart injury. The result showed that (1) the biomechanical response of the heart model was agree with the test data; (2) the contact force, myocardial stress and intracardiac pressure were decreased when the inclination angle was increased; (3) when the impact height was middle and the inclination angle of steering wheel was 15∘, the myocardial stress and intracardiac pressure were both maximum which indicated that the blunt heart injury was more likely to occur in this condition.

Surgical outcomes of isolated tricuspid valve procedures: repair versus replacement

BACKGROUND

Isolated tricuspid valve (ITV) operations are infrequent and the decision to operate is controversial. We report a series of ITV operations to outline the current disease status requiring this uncommon procedure with an emphasis on the results of tricuspid valve repair (TVr) versus replacement (TVR).

METHODS

Using our prospective cardiac surgery database, 57 patients who underwent ITV operations between 01/02-03/14 were identified. Median follow up time was 3.5 years [interquartile range (IQR), 0.8-6.7 years].

RESULTS

Fifty-seven patients underwent ITV surgery with a mean age of 54.4±14.9 yrs and 61% were women. Baseline characteristics were similar between patients who underwent TVr (n=18) or TVR (n=39). The etiologies of TV dysfunction were: ITV endocarditis 14/57 (25%), persistent TV regurgitation after left-sided valve surgery in 12/57 (21%), traumatic biopsies and iatrogenic injury from pacing leads in 11/57 (19%), orthotopic heart transplant 9/57 (16%), carcinoid syndrome 3/57 (5%), congenital 2/57 (5%) and idiopathic 5/57 (9%). Overall, 32/57 (56%) patients had prior heart surgery; of which 10/32 (31%) were TV procedures. Bioprosthetic prostheses were used in 34/39 (87%) patients. Of those who had repair, 11/18 (61%) had ring annuloplasty, 3/18 (17%) bicuspidization, and 3/18 (17%) De Vega annuloplasty and one had vegetectomy. Operative mortality was 5.1% (n=2) and 16.7% (n=3) for TVR and TVr groups, respectively (P=0.32), with an overall mortality rate of 8.6%. Postoperative complications included new onset renal failure in 6/39 (15%) of TVr and 2/18 (11%) of TVR (P=0.71) and there were no strokes. Overall survival rates and degree of residual RV dysfunction were similar for the two groups (both P=0.3). Five-year survival was 77% and 84% for TVr and TVR respectively (P=0.52). There was no difference in rates of recurrent tricuspid regurgitation for TVr and TVR (35.7% vs. 23.5%, respectively, P=0.4).

CONCLUSIONS

ITV surgery is associated with improved but still relatively high operative mortality. Mid-term outcomes for TVr and TVR are similar with regards to postoperative complications, survival, and freedom from recurrent tricuspid regurgitation.

Traumatic avulsion of the tricuspid valve after gas bottle explosion

We present a very rare example of chronic right heart failure caused by torrent tricuspid regurgitation. Massive right heart dilatation and severe tricuspid regurgitation due to avulsion of the tricuspid valve apparatus occurred as a result of a blunt chest trauma following the explosion of a gas bottle 20 years before admission, when the patient was a young man in Vietnam. After this incident, the patient went through a phase of severe illness, which can retrospectively be identified as an acute right heart decompensation with malaise, ankle edema, and dyspnea. Blunt chest trauma caused by explosives leading to valvular dysfunction has not been reported in the literature so far. It is remarkable that the patient not only survived this trauma, but had been managing his chronic heart failure well without medication for over 20 years.

Spontaneous Tricuspid Valve Chordal Rupture in Idiopathic Pulmonary Hypertension

Rupture of tricuspid valve is unusual, occurring mainly in the setting of blunt trauma or endomyocardial biopsy. Spontaneous tricuspid valve chordal rupture is particularly rare. We report herein a case of a patient with severe pulmonary hypertension, on the lung transplantation waiting list, who presented with spontaneous chordal rupture, exacerbation of tricuspid insufficiency and worsening of clinical status. Diagnosis and treatment, along with possible mechanisms for this complication, are discussed.