Cor Vasa 2009, 51(11-12):813-816 | DOI: 10.33678/cor.2009.195

Primary tricuspid regurgitation resulting from blunt chest injury sustained in a car accident

Alena Pravečková^1,*, Tomáš Paleček¹, Petr Kuchynka¹, Jaroslav Lindner², Aleš Linhart¹

¹ 2. interní klinika kardiologie a angiologie

² 2. chirurgická klinika kardiovaskulární chirurgie, Všeobecná fakultní nemocnice a 1. lékařská fakulta Univerzity Karlovy, Praha, Česká republika

Traumatic tricuspid regurgitation is generally considered a rare complication of blunt non-penetrating chest injury. However, its incidence has been reported to be increasing in recent decades. The most common cause of tricuspid valve trauma injury are road accidents and the higher proportion of car equipped with airbags, with the latter potentially contributing to the mechanism of injury. Impact to the chest may result in various types of the valve chordae, dominated by chordal rupture followed by papillary muscle rupture, and cusp tear. The clinical pattern may thus be most varied-from acute right-heart failure to an asymptomatic course. The current principal diagnostic method is echocardiography, capable of assessing the hemodynamic significance of tricuspid regurgitation and identifying its morphological cause. Optimal therapy continues to be open to debate. However, surgical correction of the defect, ideally taking the form of sparing surgery, should be doubtless performed before right ventricular dysfunction has developed.
The authors present the case of a 53-year-old man sustaining blunt chest injury in a car accident. One year later, the patient was examined for progressive dyspnea and symptoms of right-heart failure. Echocardiography demonstrated significant tricuspid regurgitation in the presence of anterior papillary muscle rupture. The patient's condition required surgery; as valve-sparing surgery could not be undertaken given the atrophy and retracted remnants of the valvular chordae, valve replacement was performed.

Keywords: Tricuspid regurgitation; Papillary muscle rupture; Right ventricular dysfunction

Published: November 1, 2009  Show citation