title: Surgical treatment of traumatic tricuspid insufficiency: experience in 13 cases.
abstract: BACKGROUND
  Traumatic tricuspid insufficiency (TTI) is uncommon and surgical experience is limited. We report our surgical experience with TTI in 13 patients.
  
  
  METHODS
  From January 2000 through March 2008, we operated on 13 patients with TTI (10 men 3 women; mean age, 39.8 ± 10.5 years). The intervals from trauma to diagnosis and from trauma to surgery averaged 37.4 and 54.4 months, respectively. At operation, the mechanism of TTI was due to anterior chordal rupture in 8, anterior papillary muscle rupture in 3, rupture of anterior papillary muscle and chordae in 1, and anterior leaflet defect in 1. In 7 patients the annulus was dilated. Valve repair was successful in 13 patients.
  
  
  RESULTS
  No early or late deaths occurred. Severe hemolysis occurred in 1 patient after tricuspid and mitral valve repairs. At follow-up extending to 9.5 years, 9 patients were in New York Heart Association functional class I, and 4 were in class II. Transthoracic echocardiography demonstrated no or trivial residual regurgitation in 7 patients, mild regurgitation in 4, and mild-to-moderate regurgitation in 2. A significant decrease of the right ventricular end-diastolic dimension (37.7 ± 9.7 vs 20.7 ± 4.6 mm; p < 0.001) was observed. The mean transvalvular gradient was 2.5 ± 0.8 mm Hg. Eleven patients were in sinus rhythm.
  
  
  CONCLUSIONS
  Satisfactory early and midterm outcomes can be achieved for TTI by tricuspid valve repair. Early surgical intervention should be emphasized to achieve good functional results and preserve the right ventricular function.
authors.affiliation: Department of Cardiovascular Surgery, Fu Wai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Wei-Guo
authors.initials: WG
authors.lastname: Ma
authors.forename: Guo-Hua
authors.initials: GH
authors.lastname: Luo
authors.forename: Han-Song
authors.initials: HS
authors.lastname: Sun
authors.forename: Jian-Ping
authors.initials: JP
authors.lastname: Xu
authors.forename: Sheng-Shou
authors.initials: SS
authors.lastname: Hu
authors.forename: Xiao-Dong
authors.initials: XD
authors.lastname: Zhu
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000379:methods*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006335:Heart Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013898:Thoracic Injuries; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000175:diagnosis; D055815:Young Adult