The “clover technique” as a novel approach for correction of post-traumatic tricuspid regurgitation

Alfieri, Ottavio; Bonis, Michele De; Lapenna, Elisabetta; Agricola, Eustachio; Quarti, Andrea; Maisano, Francesco

doi:10.1016/s0022-5223(03)00204-6

Cited by 82 publications

(47 citation statements)

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“…The most frequently reported injury is chordal rupture (55% of the cases), followed by rupture of the anterior papillary muscle (27%) and tear of the leaflets (15%). [14] Some surgeons prefer reconstructive surgery. Implantation of artificial chordae, quadrangular resection of the flail segment, chordal transposition, and papillary muscle reimplantation have been suggested in the presence of chordal rupture or papillary muscle rupture, allowing a successful repair in about 45% of the cases.…”

Section: Discussionmentioning

confidence: 99%

Post-traumatic tricuspid insufficiency: a case report

Tütün¹,

Aksöyek²,

Parlar³

et al. 2011

Ulus Travma Acil Cerrahi Derg

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Travma sonrası triküspit yetersizliği göğüs travmasının nadir bir komplikasyonudur. On sekiz yaşında erkek hastanın bisiklet kazasında karın ve göğüs duvarının ön kısmı yaralanıyor. Kalbin inferior diyafragmatik yüzeyindeki yır-tık tedavisini yapan doktor tarafından primer dikişle onarı-lıyor. On sekiz yıl sonra, ciddi triküspit yetersizliği (3+/4+) ile hastaneye başvurdu. Operasyonda, kapak onarıma uygun değildi ve biyoprotez kapak ile değiştirildi. İzole triküspit kapak hasarıyla ilgili hemodinamik bozulma sıklıkla iyi tolere edilir. Rekonstrüktif cerrahi erken periyotta müm-kün olabilir. Gecikmiş olgularda, onarım valvüler yapıların dejenerasyonuna bağlı bazı durumlarda uygun olmayabilir. Biyolojik protezler ile replasman uzun süreli olgularda uzun dönemde en iyi sonucu verebilir.Anahtar Sözcükler: Travma; triküspit kapak yetersizliği.Post-traumatic tricuspid insufficiency is a rare complication of chest trauma. An 18-year-old male patient was injured in a bicycle accident from his abdominal and anterior chest wall. The tear on the inferior diaphragmatic surface of the heart was repaired with primary sutures by the attending surgeon. Eighteen years later, he was admitted to the hospital with severe tricuspid regurgitation (3+/4+). During the operation, the valve was determined unsuitable for repair and was replaced with a bioprosthesis. The hemodynamic aberrations relevant to an isolated tricuspid valve injury are very often well-tolerated. Reconstructive surgery may be possible in the early period. In the late cases, repair is sometimes not feasible due to degeneration of the valvular apparatus. Replacement with a biological prosthesis may give the best long-term results in longstanding cases.

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Section: Discussionmentioning

confidence: 99%

Post-traumatic tricuspid insufficiency: a case report

Tütün¹,

Aksöyek²,

Parlar³

et al. 2011

Ulus Travma Acil Cerrahi Derg

View full text Add to dashboard Cite

show abstract

“…1,[3][4][5] Other reports have demonstrated successful repair using the trabecular muscle elevation technique, 6 the leafl et transposition technique, 7 the double orifi ce technique, 8 or the clover technique. 9 In the present case, the respective papillary muscles were atrophic, and the anterior leafl et was relatively small. Although the chordae tendineae were torn, the low pressure of the right ventricle and atrium allowed repair of the tricuspid valve without repairing the chordae.…”

Section: Discussionmentioning

confidence: 41%

“…In the presence of papillary muscle rupture, muscle reimplantation was often chosen, but signifi cant residual regurgitation was not unusual. 9 When the anatomical repair of the tricuspid valve is diffi cult, bicuspidization is a useful method for repairing the valve's functionality. Also, as is often the case with traumatic tricuspid regurgitation, ring annuloplasty using a ring is necessary because the right atrium is usually enlarged when the diagnosis is made.…”

Section: Discussionmentioning

confidence: 99%

Repair of traumatic tricuspid regurgitation by bicuspidization

Doi

Takahara

Mogi

et al. 2007

Gen Thorac Cardiovasc Surg

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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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“…Valve repair, however, is not always successful, and the repair should be tailored to the specific valvular pathology. 3,4) Echocardiography is the technique of choice for evaluating suspected cardiac valve abnormalities.…”

Section: Discussionmentioning

confidence: 99%

Traumatic Tricuspid Regurgitation

Cheng

Yao

2017

Int. Heart J.

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SummaryTraumatic tricuspid regurgitation is a rare and progressive disease. Early diagnosis and surgical valve repair are very important. A 57-year-old male was referred to our hospital with a history of blunt chest trauma. Three-dimensional echocardiography showed severe tricuspid regurgitation and demonstrated two main anterior leaflet chordaes of the tricuspid valve rupture and the whole anterior leaflet prolapsed. The diagnosis was severe tricuspid regurgitation due to leaflet chordae rupture secondary to blunt chest trauma. Surgical repair of the tricuspid valve was performed in this patient. At 3-month follow-up, the right ventricle was decreased in size with significantly improved right ventricular function. The signs and symptoms of right heart failure were relieved. In this case, 3-dimensional transthoracic echocardiography enabled fast and non-invasive evaluation of the spatial destruction of the tricuspid valve and subvalvular apparatus to assist in the planning of valve repair. (Int Heart J 2017; 58: 451-453) Key words: Tricuspid valve prolapse, Valve repair, Right heart failure, Transthoracic T raumatic tricuspid regurgitation (TR) is a rare cardiovascular complication of blunt chest trauma. 1) When feasible, tricuspid valve repair is preferable to valve replacement. We report a clinical case in which we describe the usefulness of 3-dimensional (3D) transthoracic echocardiography (TTE) for the diagnosis and detailed preoperative assessment of traumatic TR to assist in planning the surgical procedure. Case ReportA 57-year-old male was referred to our hospital with increasing occurrence of palpitations, dyspnea on exertion, and fatigue. Two months prior to presentation, he suffered from a punch in the chest by door panel, including a minor rib fracture. Physical examination revealed the following: blood pressure 118/72 mmHg, heart rate 103 beats/minute, temperature 36.4°C, and respiratory rate 20 breaths/minute. Physical examination revealed hepatomegaly, peripheral edema, and a grade 3-4/6 systolic murmur at the right lower sternal edge. The initial laboratory examination demonstrated that C-reactive protein (CRP) was 26.6 mg/L (n < 8.0 mg/L), troponin I 7.2 ng/ mL (n < 0.033 ng/mL), and creatine kinase 291 U/L (n = 38-174 U/L).2D TTE revealed that the right atrium and right ventricle were dilated. RV fractional area change (FAC) was 20% (Figure 1A). Tricuspid annular plane systolic excursion (TAPSE) was 11 mm. The right ventricular systolic function was impaired. Color Doppler echocardiography demonstrated the presence of severe tricuspid regurgitation (Figure 2A). The precise mechanism for severe TR was not clearly defined. It might be functional TR with dilatation of the right heart or primary tricuspid valve pathology caused by trauma, infective endocarditis, or congenital heart disease. To better define the anatomy of the tricuspid valve, 3D TTE was performed. 3D datasets were acquired from both the right ventricle focused apical 4-chamber view and the right ventricular inflow tract view. A r...

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The “clover technique” as a novel approach for correction of post-traumatic tricuspid regurgitation

Cited by 82 publications

References 4 publications

Post-traumatic tricuspid insufficiency: a case report

Post-traumatic tricuspid insufficiency: a case report

Repair of traumatic tricuspid regurgitation by bicuspidization

Traumatic Tricuspid Regurgitation

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