Tricuspid regurgitation after blunt chest trauma

Background: Tricuspid valve lesions due to blunt chest trauma are rare. Tricuspid regurgitation and clinical signs may develop after some time, and in order to avoid overlooking the diagnosis, specially in cases of polytrauma, an appropriate diagnostic protocol is needed. Methods: Retrospectively we analysed our 11 years' experience. Frequency of injury, time from injury to diagnosis, time from diagnosis to surgery, diagnostic procedure, type of surgery and treatment results were taken into account. Results: From 3 November 1999 to 15 May 2011, 9229 open-heart surgeries were done at our institution. In 14 cases (0.15 %), not counting endocarditis, isolated tricuspid procedures were performed. There were 6 injuries, 2 penetrating and 4 blunt (0.43 %). Two 36-year old men were operated on 4 months and 11 years, respectively, after a car accident, a 48-year old man 31 years after being hit by a heavy object, and a 16- year old girl 2 months after a horse kick to her chest. In the first three cases, the diagnosis was established 4 days, 26 years and 11 years respectively after the injury, and in the last case immediately after the event. In all cases diagnosis was confirmed by ultrasound. In three patients, the valve was replaced with mechanical prosthesis, while in the last one it was repaired. In the last three cases the result was good. Considering a low probability of heart injuries in the blunt chest trauma (10 %) and 1% reported tricuspid lesions in cases of such heart injuries, among 3564 patients with blunt chest trauma recorded at our center in the same period, 3-4 cases of tricuspid injury would be expected. Only 2 of our operated on patients had an accident in the analysed period. Conclusion: Our data support the fact that an injury of the tricuspid valve due to blunt chest trauma is rare and easily overlooked. Therefore, ultrasound of the heart should be done in all cases of blunt chest trauma. If negative, it should be repeated. Transoesophageal approach is more reliable than the transthoracic one. The gold standard for therapy is a valve repair, which should be done early enough to prevent further morbidity and mortality.