Rupture of the Tricuspid Valve due to Smashing the Chest into the Steering Wheel

Abstract

A 32-year-old man was urgently referred to our hospital with severe tricuspid insufficiency following a car accident. The completely flail anterior leaflet, due to the rupture of the papillary muscles, was revealed by a two-dimensional transthoracic echocardiography. In the operation, we also detected a tear on the anterior leaflet and the rupture of numerous chordae tendineae of the other leaflets. Valve repair was not considered feasible, therefore the tricuspid valve was replaced with a 31 mm mechanical prosthesis. The patient's recovery from surgery was uneventful, and he was discharged on the seventh postoperative day.Keywords: cardiac injury, tricuspid valve, tricuspid insufficiency Introduction Unfortunately, with the increase in the number of vehicles, traffic accidents have become a serious health problem. Cardiac injuries following chest trauma vary from simple myocardial contusions to severe damage to the intracardiac structures. Traumatic tricuspid valve insufficiency is a rare clinical entity. 1� We present a patient who developed tricuspid insufficiency following blunt chest trauma. Case ReportA traffic accident in August 2011 left a 48-yearold man with thoracic and abdominal trauma, due to his chest hitting the steering wheel. Unfortunately, he was not wearing a seat belt. He was admitted to the state hospital. There, he underwent an urgent splenectomy because of massive bleeding due to splenic rupture. Also, a chest tube was inserted to treat a left-side hemopneumothorax. On the fifteenth day following the accident, he was discharged from the hospital. A few weeks later, he was referred to our hospital with complaints of palpitation, dyspnea on effort, and fatigue. A physical examination revealed hepatomegaly, distention of the juguler veins, peripheral edema and a 3-4/6 systolic murmur on the left lateral sternal border. The cardiac silhouette was enlarged with a chest X-ray. A two-dimensional transthoracic echocardiography showed dilatation of the right atrium (approximately 6.5 cm), and severe tricuspid regurgitation due to papillary muscle rupture (Fig. 1). Coronary angiography revealed normal coronary arteries. On the basis of these findings, the patient was taken to surgery.A cardiopulmonary bypass was performed using aortic and bicaval cannulation. Moderate systemic hypothermia, topical cooling and antegrade cold blood cardioplegia were used for myocardial protection. After the midsternotomy and pericardiotomy, a large amount of haemorrhagic pericardial effusion was evacuated.When the right atrium was opened, the anterior and the posterior papillary muscles were found to be ruptured (Fig. 2). In addition to numerous ruptured chordae tendineae, there was a tear on the anterior leaflet.Valve repair was not suitable for this case, therefore the tricuspid valve was replaced with a 31 mm mechanical prosthesis. A temporary epicardial pacemaker wire was inserted. Sinus rhythm spontaneously resumed. The Case Report Ann Thorac Cardiovasc Surg 2013; 19: 222-224 Online November 15, 2012 doi: 10.5...

Surgical outcomes of isolated tricuspid valve procedures: repair versus replacement

“…There was no statistical difference in baseline characteristics between the TVR and TVr groups. The majority of patients, 54% (31/57) had history of at least one prior cardiac operation with 61% [11] of the repair group and 51% [20] of the replacement group (P=0.78). Of these reoperative cases, 29% (9/31) had prior TV surgeries (5 prior TVR, 4 TVr) ( Table 1).…”

“…Trauma is a rare but well described etiology of TV incompetence (11,12). TV pathology after blunt trauma is less common than aortic valve injury (12) and medical management is possible if TR is well tolerated.…”

Spontaneous Tricuspid Valve Chordal Rupture in Idiopathic Pulmonary Hypertension

“…Tricuspid valve rupture is rare and mainly associated with trauma . Spontaneous rupture of tricuspid valve apparatus is even less common; it has been described in the fetus and the neonate, predominantly associated with hypoxic insult to the papillary muscles, but very rarely in adults.…”

“…Rupture of tricuspid valve is an unusual occurrence; it has been described mainly in the setting of blunt trauma or endomyocardial biopsy, but spontaneous chordal or papillary muscle rupture of this valve is particularly rare. We report a case of a patient with severe pulmonary hypertension, on the lung transplantation waiting list that presented with chordal rupture, exacerbation of tricuspid insufficiency, and worsening of clinical status.…”

Narrow, Highly Mobile Structure in the Right Atrium: Large Eustachian Valve, Prominent Chiari Network, Thrombus, Vegetation, or Flail Tricuspid Chordae Tendineae?

“…1 These data supported the findings of several previous isolated reports and case series indicating that blunt thoracic trauma resulting from a motor vehicle accident is often responsible for disruption of the tricuspid valve apparatus, most likely because of its anterior location in the mediastinum behind the sternum. [2][3][4][5][6][7][8][9] Other causes of tricuspid leaflet flail include penetrating trauma, 10 repetitive endocardial biopsy after heart transplantation, 11,12 pacemaker or automated cardioverter-defibrillator lead implantation or replacement, 13-15 myxomatous degeneration, 16,17 endocarditis, 18 and congenital heart disease. 19-21 Notably, a specific cause for tricuspid chordae rupture cannot be identified in approximately 15% of cases.…”