Noji S, Kitamura N, Yamaguchi A, Shuntoh K, Kimura S, Irie H
Department of Cardiovascular Surgery, Osaka National Hospital, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1995 Nov;43(11):1845-9.
A 44-year-old man suffered from an traffic accident on May 27, 1994. He was transferred to a hospital because of emergent operation for a laceration of liver, right-sided hemothorax and pneumothorax. After surgical treatment for these lesions, he was doing well. However, systolic murmur appeared from August, 1994. By echocardiography and cardiac catheterization, he was diagnosed of isolated tricuspid regurgitation due to traumatic ruptured papillary muscle. Because right heart failure was progressive, an operation was recommended. At operation, annular dilatation of tricuspid valve and ruptured papillary muscle of anterior leaflet were found. And the ruptured end of right ventricular aspect was recognized. Therefore, we performed tricuspid valvuloplasty and annuloplasty. Postoperative course was uneventful. And residual regurgitation was not detected by right ventriculography. Especially, in patients with tricuspid regurgitation due to ruptured papillary muscle, symptoms usually begin soon after trauma. Therefore, an operation should be recommended promptly in the presence of right heart failure not relieved by medical treatment. And an earlier operation could increase the feasibility of tricuspid valvuloplaty, and the possibility of maintaining sinus rhythm.
一名44岁男性于1994年5月27日遭遇交通事故。他因肝裂伤、右侧血胸和气胸而紧急手术，随后被转至一家医院。对这些损伤进行手术治疗后，他恢复良好。然而，自1994年8月起出现收缩期杂音。经超声心动图和心导管检查，他被诊断为因外伤性乳头肌破裂导致的单纯三尖瓣反流。由于右心衰竭呈进行性发展，建议进行手术。手术中发现三尖瓣环扩张及前叶乳头肌破裂，并识别出右心室侧的破裂端。因此，我们进行了三尖瓣成形术和瓣环成形术。术后病程顺利，右心室造影未检测到残余反流。特别是，对于因乳头肌破裂导致三尖瓣反流的患者，症状通常在创伤后不久就开始出现。因此，在药物治疗无法缓解右心衰竭的情况下，应及时建议手术。早期手术可提高三尖瓣成形术的可行性，并增加维持窦性心律的可能性。
