PMC7150701_01
Abrasion marks on the anterior chest wall secondary to blunt chest trauma.
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He had abrasion marks on the chest (Figure 1).
(a) Transthoracic apical 4-chamber echocardiographic view showing flail anterior tricuspid valve leaflet (arrow) and (b) transoesophageal right ventricle long axis views depicting severe tricuspid valve regurgitation.
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TTE, a moderately enlarged right ventricle (RV) and right atrium, with preserved RV systolic function, was noted. There was a flail TV leaflet and an oscillating mass in the right atrium (Figure 2(a)). TR with an early peaking triangular jet velocity of 2.16 m/sec (Figures 2(b) and 3(a)). There was systolic flow reversal in the hepatic veins (Figure 3(b)).
(a) Continuous wave Doppler through the tricuspid valve in 4-chamber view showing an early peaking triangular tricuspid regurgitation velocity. (b) A subcostal view showing hepatic vein systolic flow reversal due to severe tricuspid valve regurgitation on colour flow imaging.
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TR with an early peaking triangular jet velocity of 2.16 m/sec (Figures 2(b) and 3(a)). There was systolic flow reversal in the hepatic veins (Figure 3(b)).
(a) Three-dimensional view of the tricuspid valve from the right atrial aspect showing flail anterior tricuspid valve leaflet and ruptured papillary muscle (arrow) and (b) three-dimensional colour imaging showing severe tricuspid regurgitation into the right atrium.
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A 3D transoesophageal echocardiogram (TEE) was performed which confirmed a flail anterior TV leaflet due to rupture of the anterior papillary muscle (Figures 4(a), 5(a), and 5(b)). On 3D colour flow, the TR was severe, with the jet filling greater than 50% of the right atrium (Figure 4(b)).
Three-dimensional transoesophageal views of the right ventricle showing the attachment point of the anterior papillary muscle ((a) blue and (b) orange arrows) and flail anterior tricuspid leaflet with ruptured papillary muscle ((a) black arrow).
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A 3D transoesophageal echocardiogram (TEE) was performed which confirmed a flail anterior TV leaflet due to rupture of the anterior papillary muscle (Figures 4(a), 5(a), and 5(b)).
(a-c) Intraoperative images of ruptured anterior papillary muscle and its repair and (d) transthoracic postoperative right ventricular inflow view showing the repaired anterior papillary muscle (blue arrow) and annuloplasty ring (orange arrow).
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The patient underwent a successful surgical repair of the TV (Figure 6).