Outcome of surgical treatment of post-traumatic tricuspid insufficiency

Objective: To investigate the optimal time and procedure of surgical treatment of traumatic tricuspid insufficiency. Methods: From May 1984 to September 2004, eight patients underwent operation for traumatic tricuspid valve insufficiency. All patients, male, aged from 7 to 67 years [median: 38 years, mean: (38.5±18.1) years]. The intervals between trauma and operation ranged from 1 month to 20 years [median: 19 months, mean: (52.5± 80.3) months)]. In seven patients, tricuspid insufficiency was attributed to blunt chest trauma including vehicle accident in three patients and the other patient is a stab wound. Diagnosis was confirmed by echocardiography. Pre-operative cardiac functions in patients were classified as New York Heart Association ( NYHA ) classes Ⅱ-Ⅳ. During operation, the anterior leaflet of the tricuspid valve was completely or partially flailed as a result of chordal rupture in all patients. Chordal rupture of septal leaflet was found in one patient. Anterior leaflet was perforated in two patients. Septal leaflet was retracted and adherent to ventricular septum in two patients. Valve repair was intended for all patients. Finally, valve repair was performed successfully in 3 patients and tricuspid replacement was performed in 5 patients. Results: No early or late death occurred. With a follow-up through clinical manifestation and echocardiography for 7-129 months [median; 39 months, mean: (53.4±42.8) months], all patients were classified as NYHA class I, without any changes. Conclusions : The satisfactory treatment of traumatic tricuspid insufficiency can be obtained by surgical treatment. Earlier surgery may increase the feasibility of tricuspid valve repair and prevent the deterioration of right ventricular function.