Repair of traumatic tricuspid valve rupture in Loeys Dietz type V

Loeys-Dietz Syndrome (LDS) is a rare connective tissue disorder that often results in vascular fragility and valvular abnormalities, most commonly, aortic dilation requiring intervention. Blunt cardiac trauma following chest injury is rare, and patients uncommonly experience isolated valvular injury. A 54-year-old woman with LDS type V without any peripheral arterial tortuosity, aortic dilation or symptoms was brought to care after being kicked in the chest by a horse. Initial assessment demonstrated a pericardial effusion for which a pericardial window was completed. She suffered worsening heart failure symptoms and cardiogenic shock, and was transferred to a higher level of care, where repeated imaging demonstrated severe tricuspid regurgitation, secondary to a flail leaflet. The tricuspid valve was repaired surgically using papillary muscle reimplantation and annuloplasty and continues to do well postoperatively. Intraoperative management of connective tissue disorders in cardiothoracic surgery patients is highly dependent on their subtype. In this case, the patient may have been at increased risk for valvular rupture due to her underlying LDS; however, this was not noted to impact tissue quality during the surgical repair, and the valve was successfully repaired using a papillary muscle reimplantation and annuloplasty approach.