Mori Kazuki, Shuto Takashi, Tashima Takahiro, Fukuda Tomoko, Takahashi Naohiko, Miyamoto Shinji
Department of Cardiovascular Surgery, Oita University, Oita, Japan.
Department of Cardiology and Clinical Examination, Oita University, Oita, Japan.
Gen Thorac Cardiovasc Surg Cases. 2025 Jun 3;4(1):27. doi: 10.1186/s44215-025-00211-8.
Valvular injuries in chest trauma mostly affect the aortic and mitral valves, but traumatic tricuspid regurgitation (TR) remains rare. This report describes the successful repair of traumatic TR secondary to papillary muscle rupture complicated with right ventricular (RV) free wall injury and atrial septal perforation.
A 50-year-old male suffered blunt chest trauma from a tree fall, leading to multiple fractures, mediastinal hematoma, and hemoperitoneum caused by splenic bleeding. Given that heart failure worsened eventually, echocardiography was conducted on day 7, showing significant TR resulting from leaflet prolapse caused by papillary muscle rupture with concomitant 4.8 mm atrial septal perforation and focal RV free wall thinning. Nonetheless, the heart failure was responsive to medical treatment. The patient was then scheduled for surgery 1 month later. The atrial septal defect was closed via direct suture closure. The RV free wall injury presented with scarring and did not require repair. The tricuspid valve repair included suturing the ruptured medial papillary muscle to the RV wall, reconstructing the ruptured posterior leaflet chordae with prosthetic chordae, and securing an annuloplasty ring. Consequently, TR was completely controlled.
Traumatic tricuspid valve injuries are rare. The optimal timing of surgery for traumatic TR remains controversial. However, early diagnosis and intervention are recommended to prevent progressive RV dysfunction and improve the success of tricuspid valve repair.
胸部创伤中的瓣膜损伤大多累及主动脉瓣和二尖瓣，但创伤性三尖瓣反流（TR）仍然罕见。本报告描述了继发于乳头肌破裂并伴有右心室（RV）游离壁损伤和房间隔穿孔的创伤性TR的成功修复。
一名50岁男性因从树上跌落遭受钝性胸部创伤，导致多处骨折、纵隔血肿以及脾破裂出血引起的血腹。鉴于最终心力衰竭加重，于第7天行超声心动图检查，显示由乳头肌破裂导致瓣叶脱垂引起的严重TR，同时伴有4.8 mm房间隔穿孔和局限性RV游离壁变薄。尽管如此，心力衰竭对药物治疗有反应。该患者随后在1个月后安排手术。房间隔缺损通过直接缝合关闭。RV游离壁损伤表现为瘢痕形成，无需修复。三尖瓣修复包括将破裂的内侧乳头肌缝合至RV壁，用人工腱索重建破裂的后叶腱索，并固定一个瓣环成形环。结果，TR得到完全控制。
创伤性三尖瓣损伤罕见。创伤性TR的最佳手术时机仍存在争议。然而，建议早期诊断和干预以预防进行性RV功能障碍并提高三尖瓣修复的成功率。
