Congedo E, Stritoni P, Valfrè C, Fasoli G, Corbara F, Scognamiglio R, Dalla Volta S, Chioin R
G Ital Cardiol. 1980;10(9):1234-42.
Three cases of traumatic tricuspid insufficiency are reported. The most consistent clinical and noninvasive cardiovascular findings were: previous nonpenetrating thorax trauma; non holosystolic murmur which increased slightly during inspiration on standing; electrocardiographic patterns of right atrial enlargement and right bundle branch block; unusual bulge along the mid-left heart border, seen on chest x-ray examination suggesting ventricular aneurysm; striking right ventricular dilatation wit paradoxical movement of the ventricular septum on ECHO. Cardiac catheterization led to definitive diagnosis by demonstrating a massive tricuspid valve incompetence with "ventricularisation" of the right atrial pressure. Some dyskinetic areas of the right ventrice, most likely due to the full-thickness contusion of the miocardial wall, seen on the right cineangiography, confirmed the diagnosis. The long-term clinical and haemodynamic follow-up was useful for monitoring the evolution of the disease. Surgery should be recommended in the presence of right-sided heart failure not relieved by adequate medical treatment, in view of the low operative risk.
本文报告了3例创伤性三尖瓣关闭不全的病例。最一致的临床和非侵入性心血管检查结果为：既往有非穿透性胸部创伤；非全收缩期杂音，站立吸气时略有增强；右心房扩大和右束支传导阻滞的心电图表现；胸部X线检查可见左心缘中部有异常膨出，提示心室瘤；超声心动图显示右心室明显扩张，室间隔有矛盾运动。心导管检查通过证实严重的三尖瓣关闭不全及右心房压力“心室化”而做出明确诊断。右心室电影血管造影显示右心室一些运动障碍区域，很可能是由于心肌壁全层挫伤所致，进一步证实了诊断。长期的临床和血流动力学随访有助于监测疾病的进展。鉴于手术风险较低，对于经充分药物治疗仍不能缓解的右侧心力衰竭患者，建议进行手术治疗。
