Repair of traumatic tricuspid regurgitation

Severe tricuspid regurgitation (TR) after blunt chest trauma is rare and often results from damage to the subvalvular apparatus. When injured, the damaged subvalvular apparatus may break immediately or at a later stage due to mechanical fatigue. We report the case of a 30-year-old man who sustained a blunt thoraco-abdominal trauma in a motorbike accident. The patient's condition immediately after the accident precluded any intervention for the moderate TR that was detected by transesophageal echocardiography. However, he later developed a severe TR which required surgical intervention 11 months after the accident. The operative findings included a ruptured anterior common chordae, a contracted and perforated anterior leaflet, and an enlarged annulus. A satisfactory valve competencewas achieved with several techniques including chordae re-implantation, suture commissurotomy, and ring annuloplasty. This report highlights the unpredictable course of deterioration in traumatic TR and the possibility of complex repair.