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右心室功能恶化进展后创伤性严重三尖瓣反流的诊断

Traumatic severe tricuspid regurgitation diagnosis after the progression of right ventricle function deterioration.

作者信息

Jung Hanna, Cho Joon Yong, Kim Gun-Jik, Lee Young Ok, Lim Kyoung Hoon, Hong Seong Wook, Jin Yehun, Son Shin-Ah

机构信息

Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea.

Trauma Center, Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea.

出版信息

Trauma Case Rep. 2019 Jul 29;23:100239. doi: 10.1016/j.tcr.2019.100239. eCollection 2019 Oct.

Abstract

Traumatic tricuspid regurgitation is a rare complication of blunt cardiac injury and frequently misdiagnosed during the initial assessment. Unfortunately, it may be diagnosed after deterioration of right ventricle function, which may be fatal to the patient. Here, we report a case of a patient with blunt chest injury complicated by a diagnosis of traumatic severe tricuspid regurgitation after deterioration of the right ventricle function even after the patient was subjected to serum cardiac enzyme normalization. The patient was a driver and admitted to the hospital owing to multiple traumatic injuries. Echocardiography was performed suspicious of blunt cardiac injury, which revealed no abnormal findings. Initial cardiac enzyme levels were high, but after serial follow-up, the levels improved. However, on day 4 of hospitalization, hemodynamic deterioration occurred owing to severe tricuspid regurgitation and delayed right ventricle dysfunction. Immediate tricuspid valve replacement was performed, however, the patient had a pronged recovery period. We believe that it is important to take into account the nature of the accident and the presentation of clinical signs and symptoms and not be blinded by laboratory test results alone; it is also important to consider performing repeated serial echocardiographic examinations for blunt cardiac injury patients.

摘要

创伤性三尖瓣反流是钝性心脏损伤的一种罕见并发症,在初始评估时经常被误诊。不幸的是,它可能在右心室功能恶化后才被诊断出来,这对患者可能是致命的。在此,我们报告一例钝性胸部损伤患者,即使在患者血清心肌酶恢复正常后,右心室功能恶化,最终被诊断为创伤性严重三尖瓣反流。该患者为一名司机,因多处创伤入院。因怀疑钝性心脏损伤进行了超声心动图检查,未发现异常。初始心肌酶水平较高,但经过系列随访后有所改善。然而,在住院第4天,由于严重的三尖瓣反流和延迟出现的右心室功能障碍,发生了血流动力学恶化。立即进行了三尖瓣置换术,但患者恢复时间较长。我们认为,重要的是要考虑事故的性质以及临床体征和症状的表现,而不能仅被实验室检查结果所蒙蔽;对钝性心脏损伤患者考虑进行重复系列超声心动图检查也很重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/72f9/6669719/9cf371888a3c/gr1.jpg

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