Clinical Communications: Adults
Traumatic Tricuspid Valve Rupture Presenting as Third-Degree Atrioventricular Block

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Abstract

Background

Cardiac valve injury after blunt chest trauma is extremely rare, and the tricuspid valve is most commonly affected because of the anterior location of the right ventricle. Tricuspid valve insufficiency can range from a subclinical presentation to acute cardiac failure.

Objective

Diagnosis is difficult in trauma patients because hypotension is usually attributed to hemorrhage and anatomical cardiac injuries might be overlooked.

Case Report

This is a case of a 70-year-old patient with a history of rheumatic heart disease who suffered a complete rupture of her papillary muscles leading to tricuspid insufficiency after a motor vehicle collision. She presented with third-degree atrioventricular block.

Conclusions

Consideration of screening for anatomical heart injuries in blunt trauma patients with new onset dysrhythmias is recommended to explain hypotension not attributable to hemorrhage.

Introduction

Although blunt thoracic trauma is common, traumatic tricuspid insufficiency is a rare complication that has been reported with increasing frequency during the last few years (1). Its presentation ranges from acute right heart failure to minimal regurgitation diagnosed years after the injury (2). Diagnosis is difficult in trauma patients because hypotension is usually attributed to hemorrhage (3). This report describes a complete tricuspid valve papillary muscle rupture after a motor vehicle collision presenting as new-onset, third-degree atrioventricular (AV) block. The importance of early diagnosis and treatment is discussed.

Section snippets

Case Report

After obtaining appropriate approval from our institution's Office of Regulatory Research Compliance, we reviewed the patient's chart and imaging records. The patient, a 70-year-old woman, was a driver involved in a motor vehicle collision with driver’s side impact requiring extrication exceeding 45 min. The patient was unconscious at the scene and in third-degree AV block with a blood pressure (BP) of 70/50 mm Hg. A transcutaneous pacer was applied and capture was obtained. Her BP rose to

Discussion

Blunt cardiac injury is most frequently associated with motor vehicle collisions, with cardiac contusion being the most common expression of cardiac injury 2, 4, 5. Traumatic tricuspid valve insufficiency (TTVI) after blunt chest trauma is extremely rare. Malangoni et al. reported only 1 such case after reviewing 6,312 trauma admissions. Nevertheless, the tricuspid is the most commonly affected valve, with about 200 cases reported in the literature (4).

The injury can be related to the

Conclusions

Traumatic tricuspid valve insufficiency secondary to papillary muscle rupture is a rare injury associated with blunt thoracic trauma. New-onset dysrhythmias, signs of heart failure, and respiratory distress that are not attributable to the patient's other injuries should prompt screening for an anatomical heart trauma using echocardiography. Although careful fluid management, pressors, and pacing might be needed in the acute phase to achieve hemodynamic stability, operative repair will be

References (17)

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Cited by (5)

  • Clinical and electrocardiographic features of complete heart block after blunt cardiac injury: A systematic review of the literature

    2017, Heart Rhythm
    Citation Excerpt :

    About 95 articles were initially analyzed, as well as their relevant references. Clinical data were available in 50 of 59 reported cases with CHB-BCI (84.7%) and in 27 of 28 those published over the past 20 years (96.4%).7–62 Detailed information on the clinical features of these 50 cases is provided, in chronological order (starting from the more recent cases), in Supplemental Table 1.

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