Traumatic Injury of the Tricuspid Valve—Navigating the Challenges in Diagnosis and Management

Longfellow, Eric; Aberle, Corinne; Lamelas, Joseph; Fabbro, II Michael; Johnson, Eric; Yu, Soojie; Augoustides, John; Fernando, Rohesh J.

doi:10.1053/j.jvca.2021.05.049

Cited by 5 publications

(4 citation statements)

References 49 publications

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“…Currently, it is more frequently reported due to better diagnostic modalities. Early diagnosis and treatment are paramount because untreated tricuspid injury can lead to right ventricular dysfunction, heart failure, and eventually, end-organ damage [ 3 , 4 ].…”

Section: Discussionmentioning

confidence: 99%

Buying time! VA-ECMO as a bridge to successful reoperative cardiac surgery in a case of traumatic tricuspid valve injury

Jacob,

Okafor,

Bhattacharyya

et al. 2023

Journal of Surgical Case Reports

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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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Section: Discussionmentioning

confidence: 99%

Buying time! VA-ECMO as a bridge to successful reoperative cardiac surgery in a case of traumatic tricuspid valve injury

Jacob,

Okafor,

Bhattacharyya

et al. 2023

Journal of Surgical Case Reports

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“…On the other hand, primary TR, characterized by isolated damage to the tricuspid valve (TV) apparatus (including tricuspid leaflets, annulus, chordae, or papillary muscles), accounts for only 8%-10% of TR cases and is often overlooked (5). This type of TR is commonly associated with endocarditis, Ebstein anomaly, tumors, iatrogenic injury, trauma, and autoimmune diseases (6)(7)(8)(9)(10). However, chordal and papillary muscle rupture leading to tricuspid valve prolapse (TVP) is an extremely rare but emergent cause of TR (11).…”

Section: Introductionmentioning

confidence: 99%

Case Report: unexpected cause of cyanosis in an infant after acute exposure to high altitude—severe tricuspid regurgitation secondary to tricuspid valve prolapse

Cui,

Yang,

et al. 2024

Front. Cardiovasc. Med.

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BackgroundSevere tricuspid regurgitation (TR) causing cyanosis with patent foramen ovale (PFO) and right-to-left atrial shunting requires a precise diagnosis for optimal therapy. Tricuspid valve prolapse (TVP) can lead to TR and is sometimes overlooked, especially in complex cases with factors like pulmonary hypertension (PH). We present an infant with cyanosis and profound TR after high-altitude exposure, initially misattributed to PH but found to be primarily due to spontaneous chordae tendineae rupture and TVP. This case underscores the challenges in diagnosing TR-induced cyanosis.Case presentationThe 3-month-old infant rapidly developed cyanosis, hypoxemia, right atrial enlargement, severe tricuspid regurgitation (TR), and patent foramen ovale (PFO) shunting after high-altitude exposure. Although echocardiography revealed tricuspid valve prolapse (TVP), initial consideration linked TR and right-to-left shunting to pulmonary hypertension (PH) due to the temporal correlation with rapid altitude exposure. Despite hemodynamic stability and the absence of respiratory distress after respiratory support and combined PH medication therapy, the persistent hypoxemia did not reverse as expected. This treatment outcome and repeated echocardiograms reminded us that TR was primarily caused by TVP rather than PH alone. Intraoperative exploration confirmed that TVP was caused by a rupture of TV chordae tendineae and anterior papillary muscle head, and the chordae tendineae/papillary muscle connection was reconstructed. After surgery, this patient was noncyanotic with an excellent long-term prognosis, a trivial TR with normal TV function being observed echocardiographically.ConclusionsTR-induced cyanosis can be not only a consequence of PH and right-sided heart dilation but also a primary condition. Repetitive reassessment should be undertaken with caution, particularly when patients are not improving on therapy in the setting of conditions known to predisposition to secondary TR. Since TVP caused by rupture of the chordae or papillary muscles is rare but fatal in children, early diagnosis is clinically substantial to proper management and satisfactory long-term outcomes.

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“…Traumatic tricuspid injury is rare and its presentation can range from asymptomatic to acute right heart failure or hemodynamically significant arrhythmia, depending on the extent of myocardial contusion, valvular injury, and resultant incompetence. 3 Diagnosis of tricuspid valve injury is made with transthoracic, or ideally transesophageal, echocardiography with identification of tricuspid regurgitation and valvular incompetence. 3 Consistent with the notoriously indolent initial presentation of traumatic tricuspid valve injury, this child’s injury was not identified until PTD 17, when TTE and TEE demonstrated acute tricuspid valvular regurgitation, with evidence of flow reversal in the IVC.…”

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confidence: 99%

“…3 Diagnosis of tricuspid valve injury is made with transthoracic, or ideally transesophageal, echocardiography with identification of tricuspid regurgitation and valvular incompetence. 3 Consistent with the notoriously indolent initial presentation of traumatic tricuspid valve injury, this child’s injury was not identified until PTD 17, when TTE and TEE demonstrated acute tricuspid valvular regurgitation, with evidence of flow reversal in the IVC. In retrospect, this child’s only initial symptom prior to liver transplant that could be attributed to tricuspid injury was new onset junctional heart rhythm on PTD 11, when a TTE with limited views failed to demonstrate tricuspid injury.…”

mentioning

confidence: 99%

Two-Stage Liver Transplantation and Tricuspid Valve Replacement After Blunt Trauma in a Pediatric Patient

Wallace,

Kastenberg,

Swendiman

et al. 2024

The American Surgeon™

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In cases of uncontrollable hepatic hemorrhage or acute hepatic failure after trauma, liver transplantation can be a lifesaving procedure. Traumatic tricuspid valve injuries are rare, and symptoms can range from indolent to acute right heart failure. When concomitant, traumatic liver transplant and tricuspid injuries have significant physiologic interplay and management implications. We present a 14-year-old male injured in an all-terrain vehicle accident, who sustained a devastating disruption of the common bile duct and celiac artery injury, leading to acute hepatic failure, necessitating a two-stage liver transplantation. He was subsequently found to have a severe traumatic tricuspid injury, which required tricuspid valve replacement. At 4 years post-injury, he is without major complications. This is the first case presentation of the cooccurrence of these complex pathologies. Importantly, we demonstrate the complex decision-making surrounding traumatic liver transplantation and timing of subsequent tricuspid valve repair, weighing the complex interplay of these 2 pathologies.

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Traumatic Injury of the Tricuspid Valve—Navigating the Challenges in Diagnosis and Management

Cited by 5 publications

References 49 publications

Buying time! VA-ECMO as a bridge to successful reoperative cardiac surgery in a case of traumatic tricuspid valve injury

Buying time! VA-ECMO as a bridge to successful reoperative cardiac surgery in a case of traumatic tricuspid valve injury

Case Report: unexpected cause of cyanosis in an infant after acute exposure to high altitude—severe tricuspid regurgitation secondary to tricuspid valve prolapse

Two-Stage Liver Transplantation and Tricuspid Valve Replacement After Blunt Trauma in a Pediatric Patient

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