A 19 year old man sustained a blunt thoracic trauma in a high velocity accident. Initial examination revealed severe thoracic injuries with bilateral haemo‐pneumothorax, pulmonary contusion and postero‐inferior mediastinal haematoma without oesophageal perforation. An ECG demonstrated right bundle branch block. Transoesophageal echocardiography revealed severe tricuspid valve insufficiency with complete prolapse of the anterior valve leaflet in the right atrium (panel A). Because of good haemodynamic tolerance, surgical correction was deferred until resolution of associated thoracic injuries.
The patient was operated on six weeks later, and a complete transection of the base of the anterior papillary muscle was demonstrated (panel B). In addition significant annular dilatation had developed. No leaflet or chordal lesions were noted. Surgical correction was performed by papillary muscle reimplantation, which was facilitated by the existence of a fibrotic scar marking the native implantation site on the anterior wall of the right ventricle (panel C, arrow). Annular dilatation was corrected by implantation of an annuloplasty ring.
Postoperative transoesophageal echocardiography showed satisfactory leaflet coaptation and only trivial residual valvular regurgitation (panel D). Subsequent patient recovery was uneventful.
