钝性胸部创伤后因心脏疝导致的迟发性右心衰竭伴三尖瓣反流
Late-Onset Right Heart Failure With Tricuspid Regurgitation Due to Cardiac Herniation After Blunt Thoracic Trauma.
作者信息
Yanagino Yusuke, Kawamura Masashi, Yoshioka Daisuke, Misumi Yusuke, Kawaura Ai, Kawamura Takuji, Saito Shunsuke, Yamauchi Takashi, Shimamura Kazuo, Miyagawa Shigeru
机构信息
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
出版信息
JACC Case Rep. 2025 Jun 11;30(14):103617. doi: 10.1016/j.jaccas.2025.103617.
BACKGROUND
Blunt thoracic trauma is a rare and potentially fatal condition, often treated acutely with minimal chronic phase reports.
CASE SUMMARY
A 63-year-old man with severe traumatic tricuspid regurgitation (TR), cardiac herniation, and heart constriction due to pericardial rupture suffered cardiac deformation and right heart failure 30 years after the trauma. Despite initial treatment, his symptoms worsened, prompting a referral for surgery. Chordal ruptures of the anterior tricuspid leaflets were observed intraoperatively. We performed tricuspid valve replacement and enlarged the pericardial defect to avoid constriction.
DISCUSSION
This case highlights the fact that cardiac herniation and traumatic tricuspid regurgitation after blunt trauma can lead to irregular heart enlargement and right-sided heart failure during the chronic phase. There is no established treatment, and this report may provide an effective treatment strategy.
TAKE-HOME MESSAGE: Surgical intervention can be effective for heart failure and ventricular deformation in chronic complications of blunt thoracic trauma.
背景
钝性胸部创伤是一种罕见且可能致命的疾病，通常进行急性治疗，关于慢性期的报告很少。
病例摘要
一名63岁男性因钝性胸部创伤导致严重创伤性三尖瓣反流（TR）、心脏疝和心包破裂引起的心脏受压，在创伤30年后出现心脏变形和右心衰竭。尽管进行了初始治疗，但其症状仍恶化，促使其转诊接受手术治疗。术中观察到三尖瓣前叶腱索断裂。我们进行了三尖瓣置换术，并扩大了心包缺损以避免心脏受压。
讨论
该病例突出了钝性创伤后心脏疝和创伤性三尖瓣反流可导致慢性期心脏不规则扩大和右心衰竭这一事实。目前尚无既定的治疗方法，本报告可能提供一种有效的治疗策略。
要点
手术干预对于钝性胸部创伤慢性并发症导致的心力衰竭和心室变形可能有效。
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