Repair of traumatic tricuspid valve rupture in Loeys Dietz type V

Background: Loeys-Dietz Syndrome (LDS) is a rare connective tissue disorder that often results in vascular fragility and valvular abnormalities, most commonly presenting with aortic dilation requiring intervention. Blunt cardiac trauma following chest injury is rare, and patients uncommonly experience isolated valvular injury. Here, we present a case of a patient with LDS type V who suffered chest trauma resulting in acute tricuspid regurgitation complicated by cardiogenic shock requiring surgical repair. Case Presentation: A 54-year-old woman with a history of cervical instability, obstructive sleep apnea, easy bruising and LDS type V with no relevant surgical history was brought to care after acute chest trauma. Initial management demonstrated a pericardial effusion for which a pericardial window was placed at an outside hospital. She was transferred to a higher level of care for worsening cardiogenic shock, and severe tricuspid regurgitation was demonstrated on imaging, secondary to a flail leaflet. The tricuspid valve was repaired surgically, and the patient was weaned off vasoactive agents before discharge. Conclusions: Intraoperative management of connective tissue disorders in cardiothoracic surgery patients is highly dependent on their subtype. In this case, the presenting patient was likely at increased risk for valvular rupture due to her underlying LDS; however, this was not noted to impact tissue quality during the surgical repair. Significant preoperative collaboration between the cardiothoracic and vascular surgical teams was imperative for anticipatory planning and should be the standard for patients with complex underlying connective tissue disorders.