Severe tricuspid regurgitation and atrioventicular block caused by blunt thoracic trauma in an elderly woman.
BACKGROUND
Symptomatic cardiac injury after blunt chest trauma is relatively rare, and valvular injury is even more rare. The valves most commonly affected are tricuspid. Automobile accidents are mostly responsible for this type of injury.


OBJECTIVE
Unlike with the mitral valve, post-traumatic tricuspid heart valve insufficiency is usually well tolerated. Indeed, severe tricuspid regurgitation can resolve spontaneously.


METHODS
A 68-year-old woman with no previous cardiac or medical history was brought to our Emergency Department after an automobile accident. She had chest pain and shortness of breath upon admission. Transthoracic echocardiographic examination revealed severe tricuspid regurgitation with rupture of the chordae tendineae and prolapse of the valve cusps into the right atrium during systole. An electrocardiogram was consistent with second-degree Mobitz II atrioventricular block on admission, which subsequently progressed to complete atrioventricular block on day 3. During follow-up with close hemodynamic monitoring, her symptoms disappeared and repeat echocardiography revealed a regression in the severity of tricuspid regurgitation. Operative repair of the tricuspid valve was deemed unnecessary and the patient was discharged with medical therapy on the eighth day after admission.


CONCLUSIONS
It is important to be aware of traumatic tricuspid regurgitation after non-penetrating chest trauma. Close follow-up may suffice in some patients with stable hemodynamic conditions, and regression of tricuspid regurgitation can be expected during follow-up.
Hasdemir
Hakan
H
Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey.
Arslan
Yücesin
Y
Alper
Ahmet
A
Osmonov
Damirbek
D
Güvenç
Tolga S
TS
Poyraz
Esra
E
Akyüz
Sükrü
S
Yıldız
Mustafa
M
D000063:Accidents, Traffic; D000368:Aged; D054537:Atrioventricular Block / Q000175:diagnosis / Q000209:etiology*; D006328:Cardiac Catheterization; D002637:Chest Pain / Q000209:etiology; D004417:Dyspnea / Q000209:etiology; D004452:Echocardiography; D005260:Female; D006801:Humans; D012720:Severity of Illness Index; D013898:Thoracic Injuries / Q000150:complications*; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000209:etiology*; D057832:Watchful Waiting; D014949:Wounds, Nonpenetrating / Q000150:complications*