Maisano F, Lorusso R, Sandrelli L, Torracca L, Coletti G, La Canna G, Alfieri O
II Division of Cardiac Surgery, Spedali Civili di Brescia, Italy.
Eur J Cardiothorac Surg. 1996;10(10):867-73. doi: 10.1016/s1010-7940(96)80313-7.
The review of six cases of valve repair for traumatic tricuspid regurgitation in our institution and 74 in the literature in order to assess effective methods of treating this lesion.
Tricuspid valve regurgitation is a rare complication of blunt chest trauma. Optimal treatment for this condition is still controversial ranging from long-term medical therapy to early surgical correction. We followed the cases of six consecutive patients with post-traumatic tricuspid incompetence who were successfully treated with reparative techniques. All patients were male and their ages ranged from 18 years to 42 years. Valve regurgitation was always secondary to blunt chest trauma due to motor vehicle accident. The mechanism of valve insufficiency was invariably anterior leaflet prolapse due to chordal or papillary muscle rupture associated with annular dilatation. Surgical procedures included Carpentier ring implant (5 patients), Bex posterior annuloplasty (1 patient), implant of artificial chordae (4 patients), papillary muscle reinsertion (2 patients), commissuroplasty (1 patient) and "artificial double orifice" technique (1 patient).
Tricuspid insufficiency improved in all patients after the correction. No complications were recorded and all patients were asymptomatic at the follow-up.
Since post-traumatic tricuspid regurgitation is effectively correctable with reparative techniques, early operation is recommended to relieve symptoms and to prevent right ventricular dysfunction.
回顾我院6例创伤性三尖瓣反流瓣膜修复病例及文献报道的74例病例，以评估治疗该病变的有效方法。
三尖瓣反流是钝性胸部创伤的罕见并发症。对于这种情况的最佳治疗方法仍存在争议，从长期药物治疗到早期手术矫正。我们追踪了6例连续的创伤后三尖瓣关闭不全患者，他们均通过修复技术成功治疗。所有患者均为男性，年龄在18岁至42岁之间。瓣膜反流总是继发于机动车事故导致的钝性胸部创伤。瓣膜功能不全的机制总是由于与瓣环扩张相关的腱索或乳头肌破裂导致前叶脱垂。手术方法包括植入Carpentier环（5例）、Bex后瓣环成形术（1例）、植入人工腱索（4例）、乳头肌重新植入（2例）、交界切开术（1例）和“人工双孔”技术（1例）。
矫正后所有患者的三尖瓣关闭不全均得到改善。未记录到并发症，所有患者在随访时均无症状。
由于创伤后三尖瓣反流可通过修复技术有效矫正，建议早期手术以缓解症状并预防右心室功能障碍。
