Traumatic Tricuspid Regurgitation Research Articles

Abstract 17742: Anterior Papillary Muscle Rupture After a Motor Vehicle Collision: A Rare Case of Torrential Tricuspid Regurgitation After Blunt Cardiac Injury

Introduction: Blunt cardiac injury is difficult to diagnose in the setting of polytrauma. Here we present a rare case of a torrential tricuspid regurgitation from a ruptured anterior papillary muscle after a motor vehicle collision (MVC). Case: A 55-year-old male presented to the ED after an MVC. He was hemodynamically unstable and hypoxic en route complaining of severe chest and left leg pain. Imaging demonstrated multiple rib fractures, a left acetabular fracture, and left open distal femur fracture. EKG identified atrial fibrillation with RVR and nonspecific ST changes. Labs were significant for leukocytosis and a troponin elevation to 11.98 concerning for blunt cardiac injury. A TTE demonstrated a mobile density in the RA and RV consistent with papillary muscle rupture and severe tricuspid regurgitation. An underfilled left ventricle compressed by the right heart and dilated RV were noted with septal flattening consistent with RV pressure and volume overload. Cardiothoracic surgery was consulted and recommended delayed tricuspid valve repair after other acute injuries were addressed considering the need for full anticoagulation. While in the ICU, his orthopedic injuries were addressed though his hemodynamics were complicated by frequent orthopedic interventions requiring blood transfusions. He later underwent TV replacement and it was found that the anterior papillary muscle was ruptured at its base without leaflet perforation. One week post-operatively the patient suffered a hypoxic PEA arrest. The shock team was consulted and he underwent bedside ECMO cannulation with impella placement for LV failure. After ten days on ECMO he was decannulated. Ultimately, the patient recovered well and was discharged to acute rehab. Discussion: MVCs are a leading cause of traumatic tricuspid insufficiency. However, this life-threatening condition may go undetected due polytrauma and the presence of coexisting distracting injuries. Guidelines are needed for the specific management of traumatic tricuspid regurgitation and associated right heart dysfunction. Additionally, the need for multiple surgical interventions can preclude anticoagulation which is a unique barrier to urgent valve replacement in these patients.

Traumatic Tricuspid Regurgitation as a Cause of Failure to Wean from Mechanical Ventilation

A 55-year-old man underwent emergent sternotomy due to cardiac tamponade occurring just after an accidental fall from a 10-m height. Tricuspid valve regurgitation was found on echocardiography while he was on mechanical ventilation after the operation. The patient was weaned successfully from mechanical ventilation after tricuspid valve repair under cardiopulmonary bypass. Traumatic tricuspid valve regurgitation is a rare blunt chest injury and its symptoms occur late. Tricuspid regurgitation should be considered as a reason for failure to wean from mechanical ventilation after blunt cardiac trauma. Keywords: Tricuspid valve regurgitation; Trauma; Cardiac tamponade

Traumatic tricuspid regurgitation in a pediatric patient: Is an early diagnosis possible?

Traumatic tricuspid regurgitation in a pediatric patient: Is an early diagnosis possible?

TRAUMATIC TRICUSPID REGURGITATION: WHEN TO OPERATE

Traumatic tricuspid regurgitation (TTR) is a rare complication of blunt chest trauma and results from damage to the subvalvular tricuspid apparatus. We present a rare case of severe TTR without hemodynamic compromise managed conservatively. 26 year old male admitted to trauma surgery service after

Undiagnosed Traumatic Tricuspid Regurgitation Identified by Intraoperative Transesophageal Echocardiography

Undiagnosed Traumatic Tricuspid Regurgitation Identified by Intraoperative Transesophageal Echocardiography

Blunt cardiac injury without external evidence of thoracic trauma: A report of two pediatric cases

Objective: To report two cases of cardiac injury following blunt thoracic trauma without external evidence of injury. Design: Case report and review of the literature. Setting: A 23-bed pediatric intensive care unit in an academic children’s hospital. Interventions: Two children presented following significant thoracic trauma without external evidence of injury. Cardiac injury was not initially suspected, and lack of definitive diagnostic evaluation led to a delay in diagnosis and definitive treatment. Results: A 4-year-old girl presented 6 months after initial injury and evaluation with massive right ventricular dilatation secondary to traumatic tricuspid regurgitation. The second patient, an 11-year-old boy, underwent a laparotomy for suspected abdominal pathology delaying diagnosis of his traumatic ventricular septal defect and definitive repair until clinical hemodynamic deterioration occurred. Conclusion: Clinicians should maintain a high index of suspicion for cardiac injury in patients with a significant mechanism of thoracic trauma despite external evidence. Standard screening tests are often inadequate and echocardiography should be performed for any suspected cardiac trauma.

ACUTE TRICUSPID VALVE REGURGITATION CAUSED BY SEVERE BLUNT CHEST TRAUMA

Traumatic tricuspid regurgitation (TR) has various clinical presentations and most often results in valve replacement. Unlike rupture of cardiac wall or left sided valves, tricuspid valve rupture usually does not result in immediate hemodynamic instability and may go undiagnosed. 19 year old man

Traumatic tricuspid regurgitation with ruptured chordae tendinae caused by a punch in the chest

Traumatic tricuspid regurgitation with ruptured chordae tendinae caused by a punch in the chest

うっ血による高度肝障害を合併した外傷性三尖弁閉鎖不全症の1例

症例は67歳，男性．24歳時に交通外傷により前胸部を強打した．その後，全身倦怠感が出現し，心拡大も指摘され内服加療されていた．40歳代にEbstein病と診断されたが，手術はすすめられなかった．その後も内科的治療を継続されていたが心不全の増悪を繰り返すため当科紹介された．心エコー検査にて三尖弁付着異常なく，外傷が原因と考えらえる弁尖の裂開を前尖に1カ所と弁輪の著明な拡大を認め，両者による高度の三尖弁逆流をきたしていた．術前にうっ血が原因と考えられる高度肝機能障害（Child-Pugh class B, MELD score 15点）を合併していた．手術は心停止下に三尖弁置換術を施行した．術後に難治性の胸水貯留に対して術後2カ月目に胸膜癒着術を施行した．その後も心不全治療を必要とし，術後6カ月目に自宅に退院となった．

Surgery for severe tricuspid valve regurgitation following blunt thoracic trauma

Background Heart valve injuries due to non-penetrating blunt thoracic trauma are rare with aortic valve being the most vulnerable. Tricuspid valve injury resulting in severe regurgitation is unusual after blunt chest trauma. Two major issues for the management of traumatic tricuspid regurgitation are timing and type of the operation. Valve repair is naturally the first choice but valve replacement may be required in severely destructed valves with good surgical outcomes.

HEART's Original [症例] チアノーゼを呈し,Ebstein奇形との鑑別を要した外傷性三尖弁閉鎖不全症の1例

HEART's Original [症例] チアノーゼを呈し,Ebstein奇形との鑑別を要した外傷性三尖弁閉鎖不全症の1例

A Case of Traumatic Tricuspid Regurgitation Caused by Multiple Papillary Muscle Rupture

Traumatic tricuspid regurgitation is a rare complication of blunt chest trauma. With the increase in the number of automobile accidents, traumatic tricuspid regurgitation has become an important problem after blunt chest trauma. It has been reported more frequently because of better diagnostic procedures and a better understanding of the pathology. The early diagnosis of traumatic tricuspid regurgitation is important because traumatic tricuspid injury could be effectively corrected with reparative techniques, early operation is considered to relieve symptoms and to prevent right ventricular dysfunction. Echocardiography can reveal the cause and severity of regurgitation. We experienced a case of tricuspid regurgitation after blunt chest trauma early diagnosis and valve repair were performed. This case reminds the physicians in the emergency department should be aware of this potential complication following non-penetrating chest trauma and echocardiography is useful and should play an early role.

Traumatic Ventricular Septal Defect and Tricuspid Regurgitation

TRAUMATIC VENTRICULAR SEPTAL DEFECT AND TRICUSPID REGURGITATION Joseph Shiber, MD,* and Marcelo Cardarelli, MD† *Department of Surgical Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland, and †Director of Pediatric Cardiac Surgery, University of Maryland, Baltimore, Maryland Reprint Address: Joseph Shiber, MD, Medical Intensivist, The Methodist Hospital, 6565 Fannin St., Houston, TX 77030

Severe Tricuspid Regurgitation and Atrioventicular Block Caused by Blunt Thoracic Trauma in an Elderly Woman

BackgroundSymptomatic cardiac injury after blunt chest trauma is relatively rare, and valvular injury is even more rare. The valves most commonly affected are tricuspid. Automobile accidents are mostly responsible for this type of injury. ObjectivesUnlike with the mitral valve, post-traumatic tricuspid heart valve insufficiency is usually well tolerated. Indeed, severe tricuspid regurgitation can resolve spontaneously. Case ReportA 68-year-old woman with no previous cardiac or medical history was brought to our Emergency Department after an automobile accident. She had chest pain and shortness of breath upon admission. Transthoracic echocardiographic examination revealed severe tricuspid regurgitation with rupture of the chordae tendineae and prolapse of the valve cusps into the right atrium during systole. An electrocardiogram was consistent with second-degree Mobitz II atrioventricular block on admission, which subsequently progressed to complete atrioventricular block on day 3. During follow-up with close hemodynamic monitoring, her symptoms disappeared and repeat echocardiography revealed a regression in the severity of tricuspid regurgitation. Operative repair of the tricuspid valve was deemed unnecessary and the patient was discharged with medical therapy on the eighth day after admission. ConclusionsIt is important to be aware of traumatic tricuspid regurgitation after non-penetrating chest trauma. Close follow-up may suffice in some patients with stable hemodynamic conditions, and regression of tricuspid regurgitation can be expected during follow-up.

Traumatic Tricuspid Regurgitation Caused by Myocardial Laceration: A Three-Dimensional Echocardiographic Study

A 19-year-old man was admitted for severe traumatic tricuspid regurgitation (TR) 4 months after a traffic accident. Transthoracic echocardiography revealed severe TR, with an abnormal chordal structure. Three-dimensional echocardiography showed widely lacerated right ventricular endocardium involving many subvalvular components. In this case of traumatic TR, three-dimensional echocardiography was useful not only for its diagnosis but also in providing important information for surgical decision making.

Incidence, Risk Factors, and Outcome of Traumatic Tricuspid Regurgitation After Percutaneous Ventricular Lead Removal

This study sought to evaluate the incidence, risk factors, and outcome of traumatic tricuspid regurgitation (TTR) induced by percutaneous removal of chronically implanted transvenous leads. Although lead removal using modern tools has been shown to be highly effective and safe, TTR has not been systematically evaluated. All patients undergoing ventricular lead removal at our center were studied. Lead removal was performed by simple traction, laser sheath, and/or lasso technique. Presence of a new TTR after removal was assessed by transthoracic echocardiography. Pre-defined clinical and technical parameters were studied for their association with TTR. Patients were followed up by outpatient visits. We removed 237 ventricular leads in 208 patients. Median time from lead implantation was 46.4 months (range 0.7 to 260.5 months). A TTR occurred in 19 patients (9.1%), severe in 14. Three independent risk factors of TTR were found: use of laser sheath (p = 0.004), use of both laser sheath and lasso (p = 0.02), and female sex (p = 0.02). After a follow-up of 4,130 person-months (median 17.9 months), 5 TTR patients were medically treated for new right-sided heart failure symptoms, 2 had undergone surgical repair of the tricuspid valve, and 6 had died (2 from heart failure and 4 from noncardiac causes). Right-sided heart failure occurred only in patients with severe TTR. This study found that TTR is not uncommon after percutaneous lead removal. It is strongly associated with the use of additional tools beyond simple traction and also with female sex. In the long term, right-sided heart failure is frequent in patients with severe TTR.

Editorial comment on valve repair for traumatic tricuspid regurgitation

In this chapter of the MMCTS, Malaisrie and coworkers describe a very interesting case of severe post-traumatic tricuspid regurgitation which was successfully corrected by resecting a flail segment of the anterior leaflet of the tricuspid valve w1x. A tricuspid annuloplasty ring (Edwards MC3) was used to treat the associated annular dilatation and stabilize the repair. No residual tricuspid regurgitation was present at the trans-esophageal exam performed before leaving the operating room. Although long-term echocardiographic follow-up is mandatory to confirm the durability of the repair, the Authors have to be congratulated for the excellent early result obtained in this patient in whom, in addition, they used a minimally invasive approach rather than a standard median sternotomy. Surgical correction of traumatic tricuspid regurgitation can be unpredictable and challenging. At the time of surgery it is not unusual to find multiple and different lesions involving the leaflets and the subvalvular apparatus, together with some degree of right ventricular dilatation and dysfunction. The leaflet resection technique, adopted in this case, was certainly a reasonable solution considering that the lesion encountered was represented by an isolated flail of the anterior leaflet. Nevertheless, in the presence of severe right ventricular dilatation, the application of this method can lead to significant residual regurgitation. In fact, in longstanding undiagnosed tricuspid insufficiency, the segmental flail initially caused by the blunt chest trauma is gradually followed by the development of tethering defects of the remaining portions of the valve due to the progressive enlargement of the right ventricular chamber. When this stage has been reached, resection of the flailing segment

Repair of traumatic tricuspid regurgitation by bicuspidization

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.

CT19P TRICUSPID VALVE REPAIR IN ‘TORRENTIAL TRICUSPID REGURGITATION’ FOLLOWING PERMANENT PACEMAKER LEAD EXTRACTION – A CASE REPORT

Introduction Traumatic tricuspid regurgitation secondary to blunt chest trauma has been reported in literature. We report our experience with a case of ‘Torrential Tricuspid Regurgitation’ following permanent pacemaker lead extraction which was successfully treated with tricuspid valve repair and annuloplasty.Report A 67 year old woman was treated for Sick sinus syndrome with permanent pacemaker implant. She had three generator changes for end of life and repositioning.Erosion of generator, led cardiologist to plan lead and generator extraction with the surgical backup. During lead extraction a small piece of papillary muscle was avulsed. The patient remained hemodynamically stable in the theatre. However in ward she developed right sided cardiac failure not responding to conservative therapy. A transthoracic echo (TTE) revealed torrential tricuspid regurgitation with a freely mobile posterior leaflet with attached chordae and avulsed papillary muscle.During surgery the tricuspid valve was successfully repaired and transesophageal (TOE) images showed trivial to mild tricuspid regurgitation at the end of repair procedure. Additional procedure also included ligation of both atrial appendages and implantation of epicardial leads and pacemaker. Patient made good recovery from operation.Conclusion To the best of our knowledge this is first report of repair of tricuspid valve in ‘Torrential Tricuspid Regurgitation’ following pacemaker lead extraction. We share our experience with tricuspid valve repair technique and annuloplasty.

Correction of Traumatic Tricuspid Insufficiency Using the Double Orifice Technique

Traumatic tricuspid insufficiency is an uncommon clinical condition and surgical procedures vary. In this paper we report our experience in treating traumatic tricuspid insufficiency using the double orifice technique. From January 2000 to September 2003, 10 patients with traumatic tricuspid regurgitation were admitted to our hospital, 5 of whom were corrected using the double orifice technique. There were 4 males and 1 female with ages ranging from 31 to 52 years. Preoperative transthoracic echocardiography (TTE) detected severe tricuspid regurgitation in 4 patients and moderate tricuspid regurgitation in 1 patient. At surgery, tear of the tricuspid anterior papillary muscle was found in 2 cases and anterior chordal rupture in 3 cases. The valves were successfully repaired using the double orifice technique in combination with ring annuloplasty. There was no repeat operation, no operative complications or deaths. Before discharge, TTE detected normal tricuspid valve function in 2 cases and tiny regurgitation in 3 cases. After a follow up of 8 to 36 months, TTE demonstrated normal valve function in 1 patient and tiny regurgitation in 4 patients. The double orifice technique appears to be a simple but effective method of repairing traumatic tricuspid incompetence. Satisfactory clinical outcomes can be produced in carefully selected patients.