Severe Tricuspid Regurgitation and Atrioventicular Block Caused by Blunt Thoracic Trauma in an Elderly Woman

• Published in: The Journal of emergency medicine 2012-09, Vol.43 (3), p.445-447
• Main Authors: Hasdemir, Hakan, MD, Arslan, Yücesin, MD, Alper, Ahmet, MD, Osmonov, Damirbek, MD, Güvenç, Tolga S., MD, Poyraz, Esra, MD, Akyüz, Şükrü, MD, Yldz, Mustafa, MD
• Format: Article
• Language: English
• Subjects: Accidents, Traffic; Aged; Atrioventricular Block - diagnosis; Atrioventricular Block - etiology; blunt thoracic injury; Cardiac Catheterization; Chest Pain - etiology; Dyspnea - etiology; Echocardiography; Emergency; Female; Humans; Severity of Illness Index; Thoracic Injuries - complications; treatment; tricuspid valve; Tricuspid Valve Insufficiency - diagnosis; Tricuspid Valve Insufficiency - etiology; Watchful Waiting; Wounds, Nonpenetrating - complications
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2010.05.069

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