Clinical Communications: AdultsTraumatic Tricuspid Valve Rupture Presenting as Third-Degree Atrioventricular Block
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
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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 RhythmCitation 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.
Aversion for Avulsion: A Case of Delayed Diagnosis of Traumatic Tricuspid Rupture
2019, Case Reports in AnesthesiologyThe Role of Troponin in Blunt Cardiac Injury After Multiple Trauma in Humans
2017, World Journal of SurgeryCardiac Injury after All-Terrain Vehicle Accidents in 2 Children and a Review of the Literature
2016, Pediatric Emergency Care
Streaming videos: Two brief real-time video clips that accompany this article are available in streaming video at www.journals.elsevierhealth.com/periodicals/jem. Click on Video Clips 1 and 2.