Severe Aortic and Tricuspid Valve Regurgitation after Blunt Chest Trauma: An Unusual Presentation

Figures

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  Figure 1. (A) Electrocardiogram showed normal sinus rhythm with right bundle branch block and left anterior fascicular block. (B and C) Chest x-ray with cardiothoracic ratio = cardiac width/thoracic width of 55%, suggestive of mild cardiomegaly. No widened mediastinum was observed.

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  Figure 2. (A) Apical five-chamber view showing a significant eccentric aortic regurgitation jet. (B) Suprasternal view with pulsed wave Doppler of the aorta showing holodiastolic flow reversal with end-diastolic velocity = 25 cm/sec, a specific sign of severe aortic regurgitation.

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  Figure 3. Still-frame images that explain the tricuspid regurgitation mechanism. (A) Right ventricular inflow view showing the tricuspid anterior leaflet prolapse (yellow arrow) and the coaptation gap where the severe tricuspid regurgitation occurs (blue arrow). (B) Right ventricular focused view: the demarcated structure corresponds to the ruptured anterior papillary muscle that was detached from right ventricular free wall (green arrow) and causes the severe anterior and posterior leaflet prolapse as the mechanism of severe tricuspid regurgitation after BCT.

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  Figure 4. (A) Intraoperative view of aortic valve with a tear in the RCC in which the cannula goes through (black arrow). (B) RCC valvuloplasty with surgical repair of its tear (black arrowhead). No abnormalities were found in the aortic wall and aortic valve annulus. LCC, Left coronary cusp; NCC: noncoronary cusp.

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  Figure 5. (A) Intraoperative photograph from right atrium view shows the tricuspid anterior leaflet prolapsed (∗) because of the anterior papillary muscle rupture (arrow), which is almost completely detached from its base. (B) Specimen of the resected tricuspid valve with its subvalvular apparatus showing the anterior papillary muscle (yellow arrowhead) is ruptured and necrotic. Tricuspid anatomy was unsuitable for repair, so replacement with a biologic prosthesis was performed.