Traumatic Tricuspid Insufficiency Requiring Valve Repair in an Acute Setting

• Published in: Hellenic journal of cardiology Vol. 56; no. 6; pp. 516 - 519
• Main Authors: Enomoto, Yoshinori, Sudo, Yoshio, Sueta, Tomonori
• Format: Journal Article
• Language: English
• Published: Netherlands 01-11-2015
• Subjects: Aged; Cardiac Surgical Procedures - methods; Cardiac Tamponade - complications; Cardiac Tamponade - surgery; Cardiopulmonary Bypass - methods; Echocardiography, Transesophageal; Female; Heart Failure - diagnostic imaging; Humans; Tricuspid Valve - diagnostic imaging; Tricuspid Valve - pathology; Tricuspid Valve Insufficiency - surgery; Wounds, Penetrating - complications
• ISSN: 2241-5955

Tricuspid insufficiency due to penetrating cardiac trauma is rare. Patients with tricuspid insufficiency due to trauma can tolerate this abnormality for months or even years. We report a case of a 66-year-old female with penetrating cardiac trauma on the right side of her heart that required tricuspid valve repair in an acute setting. She sustained cut and stab wounds on her bilateral forearms and in the neck and epigastric region. She had cardiac tamponade and developed pulseless electrical activity, which required emergency surgery. The right ventricle and superior vena cava were dissected approximately 5 cm and 2 cm, respectively. After these wounds had been repaired, the patient's inability to wean from cardiopulmonary bypass suggested rightsided heart failure; transesophageal echocardiography revealed tricuspid insufficiency. Right atriotomy was performed, and a detailed examination revealed that the tricuspid valve septal leaflet was split in two. There was also an atrial septal injury that created a connection with the left atrium; these injuries were not detected from the right ventricular wound. After repair, weaning from cardiopulmonary bypass with mild tricuspid insufficiency was achieved, and she recovered uneventfully. This case emphasized the importance of thoroughly investigating intracardiac injury and transesophageal echocardiography.