Athlete with traumatic tricuspid regurgitation - Return to competition after tricuspid valve repair

Tricuspid regurgitation (TR) is most commonly caused by increased pulmonary pressure secondarily to mitral valve abnormalities. Isolated TR is an uncommon valve lesion. The most common etiologies are postinflammatory valve disease,(1) congenital abnormalities,(2) carcinoid syndrome,(3) endocarditis secondary to IV drug abuse,(4) and disruption of leaflet function by permanent pacemaker leads through the valve into the right ventricle(5) or extraction of pacemaker leads.' The usual method of correction is tricuspid valve replacement when leaflet tissue has been destroyed, or annuloplasty in the situation of a dilated annulus and near normal leaflet function. Flail leaflet pathology is quite rare. Trauma is the usual etiology.(7,8) The usual indication for intervention has been to prevent progressive right ventricular failure from volume overload in symptomatic patients. The methods of repair reported have included placement of artificial chordae tendineae, papillary muscle repair, and adjacent leaflet transfer.(7-15) We report a case of traumatic TR in which a repair of a flail tricuspid valve segment was supported by artificial chordae tendineae. Most importantly, this repair held up to the rigors of professional athleticism with near complete right ventricular remodeling.