Surgical management of traumatic tricuspid regurgitation: a case report.

Abstract

Background: Traumatic tricuspid valve regurgitation is a rare condition related to blunt chest trauma. In the early phase, the patients may remain asymptomatic. Progressive tricuspid regurgitation leads to the development of symptoms thereafter. Progressive right ventricular dysfunction aggravates symptoms, and the diagnosis is made by subsequent echocardiography at a later time. The treatment is usually surgical, especially in younger patients.

Case summary: We describe a 30-year-old patient with traumatic tricuspid valve regurgitation after a motorcycle accident. No cardiac injury was detected at the moment of the collision, and the patient remained asymptomatic at the initial phase. Five years later, the patient was admitted to our hospital with symptoms of dyspnoea at exertion. Echocardiography demonstrated severe tricuspid valve regurgitation with right ventricle dilatation. Surgical tricuspid valve repair including ring annuloplasty and implantation of artificial chords via an endoscopic approach was performed. Surgery was complicated by impingement of the right coronary artery by one of the annuloplasty sutures, which was addressed by subsequent percutaneous coronary intervention.

Discussion: Traumatic tricuspid valve regurgitation requires careful evaluation. Transthoracic echocardiography should be recommended to exclude post-traumatic tricuspid regurgitation after major blunt chest trauma. Early diagnosis is important to avoid right ventricular failure. First-line surgical treatment consists of tricuspid repair by means of ring annuloplasty and implantation of artificial chords.