Ataka K, Ota T, Okada M, Okada K, Minami Y, Yoshimura N
Department of Surgery, Kobe University School of Medicine, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1993 Dec;41(12):2383-8.
Two cases of nonpenetrating traumatic tricuspid regurgitation were reported. The first case, a 46-year-old man who had an episode of traffic accident 21 years ago, was admitted with complaints of peripheral edema and dyspnea on exertion. The second case was a 16-year-old man who noted to have cardiac murmur and cardiomegaly after 4 years of a traffic accident. In both cases, cardiac catheterization showed increased right atrial pressure with high v wave, and echocardiogram showed severe tricuspid regurgitation with ruptured chordae tendineae of the anterior leaflet. Tricuspid valve replacement was performed successfully in both the cases. Twenty-two operated cases of traumatic tricuspid regurgitation have been reported in Japan; 17 of ruptured chordae tendineae, 3 of ruptured papillary muscle, and 2 of primary laceration of anterior leaflet. The patients with ruptured papillary muscle were operated from 2 months to 7 years (average 4 years) after trauma, while those with ruptured chordae tendineae were operated from 5 months to 25 years (average 10 years) after trauma. Tricuspid valve replacement was performed in 17 of 22 cases. From the review of 22 cases, tricuspid valve replacement should be indicated for traumatic tricuspid regurgitation in consideration of the severity of valve destruction regardless of the interval after trauma.
报告了2例非穿透性创伤性三尖瓣反流病例。第一例为一名46岁男性，21年前曾发生交通事故，因外周水肿和劳力性呼吸困难入院。第二例为一名16岁男性，在交通事故4年后发现有心脏杂音和心脏扩大。两例患者的心导管检查均显示右心房压力升高伴v波高大，超声心动图显示严重三尖瓣反流伴前叶腱索断裂。两例均成功进行了三尖瓣置换术。在日本已报告了22例创伤性三尖瓣反流手术病例；其中腱索断裂17例，乳头肌断裂3例，前叶原发性撕裂2例。乳头肌断裂患者在创伤后2个月至7年（平均4年）接受手术，而腱索断裂患者在创伤后5个月至25年（平均10年）接受手术。22例中有17例进行了三尖瓣置换术。通过对这22例病例的回顾，对于创伤性三尖瓣反流，无论创伤后的时间间隔如何，应根据瓣膜破坏的严重程度考虑进行三尖瓣置换术。
