Tricuspid valve avulsion 3 years after blunt chest trauma

Abstract

Traumatic injuries to the tricuspid valve may present years after blunt trauma and may require repair or replacement of the valve. 1 We present images of an avulsed tricuspid valve 3 years following a motor vehicle accident (MVA).A 52-year-old male with a remote history of a myocardial infarction and multivessel coronary stenting presented with right heart failure. Three years prior to admission, he underwent a splenectomy following a MVA. A transthoracic echocardiogram now revealed moderate to severe aortic regurgitation and severe tricuspid regurgitation with an end-diastolic annular dimension of 4.8 cm and a right ventricular systolic pressure of 65 mmHg (Figure 1). An unidentified structure was noted to be "floating" in the right atrium. At the time of surgery, cardiopulmonary bypass (CPB) was established with ascending aortic and bicaval cannulation. Following cardioplegic arrest with cold crystalloid St Thomas solution, a right atriotomy revealed complete avulsion of the anterior-posterior tricuspid valve leaflets from the annulus (Figure 2). The valve was repaired by reattaching the leaflets to the annulus with a running 5-0 prolene suture and performing a modified DeVega reductive annuloplasty with a running 2-0 polyfilament suture (Figure 3). A transverse aortotomy revealed an enlarged annulus with malcoaptation of the aortic valve leaflets, not thought to be related to the previous MVA. The aortic valve was replaced with a #23 St. Jude mechanical prosthesis (Abbott Inc., Abbott Park, IL). The patient was weaned off CPB following 93 min and a crossclamp time of 80 min. He had an uneventful postop course and is asymptomatic 1 year following FIGURE 1 Preoperative transesophageal 3-D echocardiography. Arrow points massive structure floating into the right atrium RA, right atrium; RV, right ventricle FIGURE 2 Gross view of the tricuspid valve before surgery J Card Surg. 2018;33:787-788. wileyonlinelibrary.com/journal/jocs

Tricuspid valve rupture after blunt thoracic trauma

“…1 Symptoms, if present, can manifest as palpitations, dyspnea, or chest pain, although these can be nonspeci c in patients with chest trauma. 2 Patients can often be asymptomatic for prolonged periods of time, making the eventual repair more challenging. 2 The mechanism of injury is often from blunt thoracic trauma secondary to motor vehicle collisions, as was the mechanism in this case, however there are reports of rupture after falls from height and proximity to explosions.…”

“…2 Patients can often be asymptomatic for prolonged periods of time, making the eventual repair more challenging. 2 The mechanism of injury is often from blunt thoracic trauma secondary to motor vehicle collisions, as was the mechanism in this case, however there are reports of rupture after falls from height and proximity to explosions. 3 The pathophysiology of TTR has been previously described as a result of a dramatic increase in pressure of the right ventricle when the tricuspid valve is closed.…”