Late presentation of traumatic tricuspid valve chordal rupture and pericardial rupture with cardiac herniation; a case report

Background Although chest trauma happens very often, accompanying tricuspid valve injuries occur rarely and may be manifested by scarce symptoms and signs. Pericardial rupture with cardiac herniation is even bigger rarity. Transthoracic echocardiography plays a key role in diagnosis of valve injuries, but has limited value in cardiac herniation.Case presentation: We present the case of 58-year old man who experienced severe chest trauma in a car accident. Symptoms of right heart failure occurred 10 years after the injury, due to the loss of tricuspid leaflet support and significant tricuspid regurgitation. Intraoperatively, old posttraumatic pericardial rupture into left pleura was also found, with partial cardiac herniation and pressure of the edge of pericardium on coronary arteries (previously thought to be myocardial bridge, on coronary angiography).Conclusions This case emphasizes the importance of timely diagnosis and underlines a mechanism that leads to delayed rupture of the tricuspid valve apparatus. Repeated echocardiography in all patients who experienced chest trauma could be of great importance.