CLINICAL SPOTLIGHT Clinical Spotlight Acute Repair of Traumatic Tricuspid Valve Regurgitation Aided by Three-Dimensional Echocardiography Paul J. Conaglen, MBChB a,* , Andris Ellims, MBBS (Hons) b , Colin Royse, MD, FANZCA c,d and Alistair Royse, MD, FRACS, FCSANZ a a Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia b Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia c Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria, Australia d Anaesthesia and Pain Management Unit, Department of Pharmacology, University of Melbourne, Melbourne, Victoria, Australia A 54 year-old man without prior cardiac history was involved in a motor vehicle accident. His heart rate was 100/min and blood pressure 128/78 mmHg. He complained of anterior chest pain, and on examination had a loud pan-systolic murmur with no clinical signs of heart failure. Three-dimensional trans-oesophageal echocardiography (3D-TOE) demonstrated partial rupture of the inferior head of the anterior papillary muscle (when 2D-TOE did not), causing severe tricuspid regurgitation. This was successfully repaired. Tricuspid valve insufficiency is a rare, but well documented, complication of blunt chest trauma. The majority of cases of tricuspid regurgitation caused by blunt trauma are diagnosed and treated late after the traumatic event. Acute diagnosis is less common but possible with a high level of vigilance, and is greatly aided by clinical indicators of cardiac injury. We describe a case of acute repair of traumatic tricuspid insufficiency, in which diagnosis and surgical planning were greatly aided by 3D-TOE. (Heart, Lung and Circulation 2011;20:237–240) © 2010 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand. Published by Elsevier Inc. All rights reserved. Keywords. Trauma; Blunt; Tricuspid valve; Rupture (tricuspid valve); Heart valve Introduction T ricuspid valve insufficiency is a rare, but well doc- umented, complication of blunt chest trauma. The incidence of blunt cardiac injury caused by trauma has been estimated at 0.2% [1], with the most common valvu- lar injury involving the tricuspid valve, due to its anterior anatomical position (immediately behind the sternum). Less commonly, other blunt traumatic cardiac injuries occur. Combination injuries of both atrioventricular valves have been reported, but these and other structural injuries are much less frequent [2,3]. Methods A case is presented, followed by a brief review of the rel- evant literature. Received 15 June 2010; received in revised form 23 October 2010; accepted 8 November 2010; available online 18 December 2010 * Corresponding author. Tel.: +61 4 315 68718. E-mail address: paulandsarahconaglen@yahoo.co.nz (P.J. Conaglen). Results A 54 year-old man without a prior cardiac history was involved in a single vehicle head on collision with a tree on non-metropolitan road at a speed estimated to be 50–80 km/h. At the scene, he was confused with heart rate 100/min, and blood pressure 128/78 mmHg. At the trauma centre, his haemodynamics were unchanged, but he was complaining of anterior chest pain with a tender but stable sternum. His jugular venous pressure was not elevated, had no peripheral oedema or hepatomegaly, but a loud pan- systolic murmur was heard at the right lower sternal edge. An electrocardiogram revealed a sinus tachycar- dia, and initial troponin I was 1.0 mcg/L (N < 0.10 mcg/L) and creatine kinase was 600 IU/L (N 30–200 IU/L). Com- puted tomography of the chest with arterial phase contrast showed bilateral anterior lung contusions, with left antero-lateral rib fractures 1–6, and right postero-lateral rib fractures 2–6. There was neither aortic dissection nor haemopneumothorax. He also sustained minimally dis- placed fractures of the right clavicle and left maxillary sinus. © 2010 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand. Published by Elsevier Inc. All rights reserved. 1443-9506/04/$36.00 doi:10.1016/j.hlc.2010.11.004