Tricuspid valve rupture after blunt thoracic trauma

Tricuspid valve rupture after blunt thoracic trauma | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Tricuspid valve rupture after blunt thoracic trauma Savan Shah, Arsalan Khan, Michael Bishop, Gillian Alex This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4132276/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 20 You are reading this latest preprint version Abstract Background Tricuspid valvular injuries are rare and often go undiagnosed, which can lead to right ventricular failure and death. Case Presentation: A 35-year-old female who presented after motor vehicle collision with multiple injuries was discovered to have a tricuspid valve rupture requiring valve replacement. In the case presented, the diagnosis was made with transthoracic echocardiography (TTE), however a subtler finding of new onset right bundle branch block was present during initial evaluation. The tricuspid valve rupture was managed with early valve replacement. Conclusions Although rare, tricuspid valve injuries can occur after blunt chest trauma and can be difficult to diagnose. Early recognition and swift treatment can prevent deadly complications. Tricuspid valve rupture blunt cardiac injury trauma thoracic Case Report A 35-year-old female presented to a community hospital as an unrestrained driver involved in a high-speed motor vehicle collision. On arrival, the patient was hemodynamically stable. Injuries included fractures of bilateral upper extremities, multiple rib fractures with bilateral pulmonary contusions, multiple transverse process vertebral fractures, and a splenic laceration. Initial echocardiogram (EKG) was abnormal with a new right bundle branch block noted. CT angiography was performed, however there were no cardiac irregularities noted. Transthoracic echocardiography (TTE) was performed on hospital day (HD) 2 given increasing shortness of breath, which revealed wide open tricuspid regurgitation (TR) with preserved left ventricular function ( Video 1 ). Given the severity of her injuries, she was transferred to a level I trauma center. Continued evaluation demonstrated significantly elevated troponin level, increasing hypoxia from multiple pulmonary contusions, and right heart strain requiring intubation. Once stable, the patient was deemed an appropriate surgical candidate for definitive surgical management. The patient was taken to the operating room on HD 6 for tricuspid valve replacement. Median sternotomy was performed, and the patient was placed on cardiopulmonary bypass (CPB). Once arrest was achieved, a right atriotomy was performed and the valve was inspected. The papillary muscle heads of the anterior and posterior leaflets were completely ruptured resulting in complete flail. There were also disruptions of the anterior valve itself, making repair unfeasible. The annulus was sized and a 33 mm St. Jude Epic bioprosthetic valve was placed. The patient was weaned from CPB with excellent hemodynamics. Transesophageal echocardiography (TEE) showed that the tricuspid valve was well seated. However, the patient developed significant hypoxia from underlying pulmonary contusions and required initiation of veno-venous extracorporeal membranous oxygenation (VV ECMO) prior to transfer to the ICU. The patient’s postoperative course was prolonged by difficulty weaning from VV ECMO, ventilator-associated pneumonia, prolonged ventilator dependence, and tracheostomy and percutaneous endoscopic gastrotomy tube placement. In total, the patient remained on ECMO for 26 days. She was subsequently discharged to inpatient rehabilitation on POD 49 and discharged home with home health services on POD 62. Discussion Traumatic tricuspid valve rupture (TTR) is a rare phenomenon that can be deadly if not identified expeditiously. Tricuspid valve injuries have been estimated to account for only 0.02% of traumatic injuries, limiting possible exposure for providers to manage this pathology effectively. 1 The vast majority of cases are caused by blunt trauma, however cases can often go missed with concomitant traumatic injuries that can mask underlying symptoms, likely underestimating the frequency at which it occurs. 1 Symptoms, if present, can manifest as palpitations, dyspnea, or chest pain, although these can be nonspecific in patients with chest trauma. 2 Patients can often be asymptomatic for prolonged periods of time, making the eventual repair more challenging. 2 The mechanism of injury is often from blunt thoracic trauma secondary to motor vehicle collisions, as was the mechanism in this case, however there are reports of rupture after falls from height and proximity to explosions. 3 The pathophysiology of TTR has been previously described as a result of a dramatic increase in pressure of the right ventricle when the tricuspid valve is closed. 3 The anatomic position of the right ventricle behind the sternum makes it susceptible to deceleration forces in blunt trauma, leading to possible chordae rupture, papillary muscle injury, or leaflet rupture. 3 EKG is the best predictor of cardiac injury after trauma, with sensitivity of up to 83%. 4 EKG abnormalities should prompt further workup for possible underlying injury. In this case, a new right bundle branch block, which can indicate the presence of TTR, was not thoroughly investigated. 3 Diagnosis has been improved with the use of cardiac biomarkers and echocardiography. 4 Troponin levels were not measured upon admission in this case, which could have elucidated possible underlying cardiac injury and prompted further workup. TTE has evolved as a useful tool for diagnosis of tricuspid valve rupture, however there are no consensus statements regarding routine use. Once TTR is determined, the timing of surgical repair is debatable, however most studies recommend early intervention to prevent the development of right ventricular failure. 3 The most common lesions that are encountered with TTR are chordal rupture, followed by papillary muscle rupture, and leaflet rupture. 5 For chordal ruptures, repair has previously been performed with the use of artificial chordae for reconstruction of the subvalvular supporting system and ring annuloplasty to reduce annular dilation. 5 For papillary muscle rupture and leaflet rupture, valve replacement has been suggested as the preferred approach given potential recurrence and the fragility of papillary muscle segments. In the case presented, valve replacement was performed given the complete destruction to the native valve. Conclusion TTR is rare, however timely diagnosis and repair are imperative. A high index of suspicion must be maintained for blunt thoracic trauma patients with elevated cardiac biomarkers, EKG abnormalities, or symptoms upon presentation. Timing of treatment is variable, depending on the priority of other concomitant injuries or degree of cardiac dysfunction, however early treatment is recommended to prevent worsening right ventricular failure. Treatment can vary between valve repair or valve replacement, depending on the specific type of lesion and severity of the injury to valvular attachments. Here, we present a case of TTR after motor vehicle collision with successful early valve replacement. Declarations Ethical Statement : Exempt from IRB. Consent for Publication : Consent obtained from patient for publication Data Availability Statement : The data utilized within this article cannot be shared due to patient privacy. The data will be shared on reasonable request to the corresponding author. Funding/Support : The authors have no financial relationships or in-kind support to disclose. Conflict of Interest: None declared. References Gayet C, Pierre B, Delahaye J-P, Champsaur G, Andre-Fouet X, Rueff P. Traumatic Tricuspid Insufficiency: An Underdiagnosed Disease. Chest . 1987/09/01/ 1987;92(3):429-432. doi:https://doi.org/10.1378/chest.92.3.429 Jonjev ŽS, Milosavljević AM, Bjeljac I, Todić M, Koruga S. Tricuspid valve avulsion 3 years after blunt chest trauma. J Card Surg Dec. 2018;33(12):787–8. 10.1111/jocs.13939 . van Son JA, Danielson GK, Schaff HV, Miller FA Jr. Traumatic tricuspid valve insufficiency: experience in thirteen patients. J Thorac Cardiovasc Surg. 1994;108(5):893–8. Alborzi Z, Zangouri V, Paydar S, et al. Diagnosing Myocardial Contusion after Blunt Chest Trauma. J Tehran Heart Cent Apr. 2016;13(2):49–54. Zhang Z, Yin K, Dong L, et al. Surgical management of traumatic tricuspid insufficiency. J Card Surg. 2017;32(6):342–6. https://doi.org/10.1111/jocs.13156 . Additional Declarations No competing interests reported. Supplementary Files Video1.mp4 Video 1. Transthoracic echocardiography (TTE) demonstrating traumatic tricuspid valve rupture. Red circle indicates injured tricuspid valve. File Type: .mp4 Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 30 Apr, 2024 Reviews received at journal 28 Apr, 2024 Reviews received at journal 23 Apr, 2024 Reviews received at journal 21 Apr, 2024 Reviews received at journal 20 Apr, 2024 Reviews received at journal 18 Apr, 2024 Reviews received at journal 17 Apr, 2024 Reviewers agreed at journal 15 Apr, 2024 Reviewers agreed at journal 14 Apr, 2024 Reviewers agreed at journal 12 Apr, 2024 Reviewers agreed at journal 12 Apr, 2024 Reviewers agreed at journal 12 Apr, 2024 Reviews received at journal 12 Apr, 2024 Reviewers agreed at journal 12 Apr, 2024 Reviewers agreed at journal 12 Apr, 2024 Reviewers agreed at journal 12 Apr, 2024 Reviewers invited by journal 12 Apr, 2024 Editor assigned by journal 20 Mar, 2024 Submission checks completed at journal 20 Mar, 2024 First submitted to journal 19 Mar, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4132276","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":281743721,"identity":"d56b365a-cd76-4fe4-a4bc-159441d2f844","order_by":0,"name":"Savan Shah","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2ElEQVRIiWNgGAWjYBCDBAYJ5gNA+gCYTawWtgSStfAYEKdFvv2M4ecChro8/tk93z7z/LnDwM+eY4BXi8GZHGPpGQyHiyXunN08m7ftGYNkzxsCWhjSEqR5GA4kNtzI3czM23CYweAGAVvk+58l/+ZhqEucfyPnMTPPn8MM9oS0MNxIPga0hTlxw40cZmYeNqAtEoT8cuPxMWsehsOJG2+kGTPObTvMI3HmWQEBhyU23wY5bN6N5McMb/4cluNvT96A32EgwPgPweYhrHwUjIJRMApGAUEAACiyR675nR8rAAAAAElFTkSuQmCC","orcid":"","institution":"Rush University Medical Center","correspondingAuthor":true,"prefix":"","firstName":"Savan","middleName":"","lastName":"Shah","suffix":""},{"id":281743722,"identity":"10ae4d5c-2f85-4171-a503-66c9dd098548","order_by":1,"name":"Arsalan Khan","email":"","orcid":"","institution":"Rush University Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Arsalan","middleName":"","lastName":"Khan","suffix":""},{"id":281743723,"identity":"cfc06d97-627d-4b69-bc88-c25c45cec3d5","order_by":2,"name":"Michael Bishop","email":"","orcid":"","institution":"Rush University Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Michael","middleName":"","lastName":"Bishop","suffix":""},{"id":281743724,"identity":"0738119b-9ce0-4d99-a0b7-529d82614e43","order_by":3,"name":"Gillian Alex","email":"","orcid":"","institution":"Rush University Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Gillian","middleName":"","lastName":"Alex","suffix":""}],"badges":[],"createdAt":"2024-03-19 17:59:36","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4132276/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4132276/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":53278284,"identity":"634cd0ae-3b35-45fa-9d4a-01a12476822b","added_by":"auto","created_at":"2024-03-22 18:38:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":166371,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4132276/v1/77ad091a-951d-4f78-986c-7d2ac9b13cab.pdf"},{"id":53278280,"identity":"94a6e4d7-2a16-4526-a42d-764fa7acc267","added_by":"auto","created_at":"2024-03-22 18:38:41","extension":"mp4","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":59161161,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eVideo 1\u003c/strong\u003e. Transthoracic echocardiography (TTE) demonstrating traumatic tricuspid valve rupture. Red circle indicates injured tricuspid valve.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFile Type: \u003c/strong\u003e.mp4\u003c/p\u003e","description":"","filename":"Video1.mp4","url":"https://assets-eu.researchsquare.com/files/rs-4132276/v1/c8b4385bb196841150a36b76.mp4"}],"financialInterests":"No competing interests reported.","formattedTitle":"Tricuspid valve rupture after blunt thoracic trauma","fulltext":[{"header":"Case Report","content":"\u003cp\u003eA 35-year-old female presented to a community hospital as an unrestrained driver involved in a high-speed motor vehicle collision. On arrival, the patient was hemodynamically stable. Injuries included fractures of bilateral upper extremities, multiple rib fractures with bilateral pulmonary contusions, multiple transverse process vertebral fractures, and a splenic laceration. Initial echocardiogram (EKG) was abnormal with a new right bundle branch block noted. CT angiography was performed, however there were no cardiac irregularities noted. Transthoracic echocardiography (TTE) was performed on hospital day (HD) 2 given increasing shortness of breath, which revealed wide open tricuspid regurgitation (TR) with preserved left ventricular function (\u003cb\u003eVideo 1\u003c/b\u003e). Given the severity of her injuries, she was transferred to a level I trauma center. Continued evaluation demonstrated significantly elevated troponin level, increasing hypoxia from multiple pulmonary contusions, and right heart strain requiring intubation.\u003c/p\u003e \u003cp\u003eOnce stable, the patient was deemed an appropriate surgical candidate for definitive surgical management. The patient was taken to the operating room on HD 6 for tricuspid valve replacement. Median sternotomy was performed, and the patient was placed on cardiopulmonary bypass (CPB). Once arrest was achieved, a right atriotomy was performed and the valve was inspected. The papillary muscle heads of the anterior and posterior leaflets were completely ruptured resulting in complete flail. There were also disruptions of the anterior valve itself, making repair unfeasible. The annulus was sized and a 33 mm St. Jude Epic bioprosthetic valve was placed. The patient was weaned from CPB with excellent hemodynamics. Transesophageal echocardiography (TEE) showed that the tricuspid valve was well seated. However, the patient developed significant hypoxia from underlying pulmonary contusions and required initiation of veno-venous extracorporeal membranous oxygenation (VV ECMO) prior to transfer to the ICU.\u003c/p\u003e \u003cp\u003eThe patient\u0026rsquo;s postoperative course was prolonged by difficulty weaning from VV ECMO, ventilator-associated pneumonia, prolonged ventilator dependence, and tracheostomy and percutaneous endoscopic gastrotomy tube placement. In total, the patient remained on ECMO for 26 days. She was subsequently discharged to inpatient rehabilitation on POD 49 and discharged home with home health services on POD 62.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eTraumatic tricuspid valve rupture (TTR) is a rare phenomenon that can be deadly if not identified expeditiously. Tricuspid valve injuries have been estimated to account for only 0.02% of traumatic injuries, limiting possible exposure for providers to manage this pathology effectively. \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e The vast majority of cases are caused by blunt trauma, however cases can often go missed with concomitant traumatic injuries that can mask underlying symptoms, likely underestimating the frequency at which it occurs. \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Symptoms, if present, can manifest as palpitations, dyspnea, or chest pain, although these can be nonspecific in patients with chest trauma. \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Patients can often be asymptomatic for prolonged periods of time, making the eventual repair more challenging. \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe mechanism of injury is often from blunt thoracic trauma secondary to motor vehicle collisions, as was the mechanism in this case, however there are reports of rupture after falls from height and proximity to explosions. \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e The pathophysiology of TTR has been previously described as a result of a dramatic increase in pressure of the right ventricle when the tricuspid valve is closed. \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e The anatomic position of the right ventricle behind the sternum makes it susceptible to deceleration forces in blunt trauma, leading to possible chordae rupture, papillary muscle injury, or leaflet rupture. \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eEKG is the best predictor of cardiac injury after trauma, with sensitivity of up to 83%.\u003csup\u003e4\u003c/sup\u003e EKG abnormalities should prompt further workup for possible underlying injury. In this case, a new right bundle branch block, which can indicate the presence of TTR, was not thoroughly investigated. \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Diagnosis has been improved with the use of cardiac biomarkers and echocardiography. \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Troponin levels were not measured upon admission in this case, which could have elucidated possible underlying cardiac injury and prompted further workup. TTE has evolved as a useful tool for diagnosis of tricuspid valve rupture, however there are no consensus statements regarding routine use.\u003c/p\u003e \u003cp\u003eOnce TTR is determined, the timing of surgical repair is debatable, however most studies recommend early intervention to prevent the development of right ventricular failure. \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e The most common lesions that are encountered with TTR are chordal rupture, followed by papillary muscle rupture, and leaflet rupture. \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e For chordal ruptures, repair has previously been performed with the use of artificial chordae for reconstruction of the subvalvular supporting system and ring annuloplasty to reduce annular dilation. \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e For papillary muscle rupture and leaflet rupture, valve replacement has been suggested as the preferred approach given potential recurrence and the fragility of papillary muscle segments. In the case presented, valve replacement was performed given the complete destruction to the native valve.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eTTR is rare, however timely diagnosis and repair are imperative. A high index of suspicion must be maintained for blunt thoracic trauma patients with elevated cardiac biomarkers, EKG abnormalities, or symptoms upon presentation. Timing of treatment is variable, depending on the priority of other concomitant injuries or degree of cardiac dysfunction, however early treatment is recommended to prevent worsening right ventricular failure. Treatment can vary between valve repair or valve replacement, depending on the specific type of lesion and severity of the injury to valvular attachments. Here, we present a case of TTR after motor vehicle collision with successful early valve replacement.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Statement\u003c/strong\u003e: Exempt from IRB.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e: Consent obtained from patient for publication\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e: The data utilized within this article cannot be shared due to patient privacy. The data will be shared on reasonable request to the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding/Support\u003c/strong\u003e: The authors have no financial relationships or in-kind support to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u0026nbsp;\u003c/strong\u003eNone declared.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003eGayet C, Pierre B, Delahaye J-P, Champsaur G, Andre-Fouet X, Rueff P. Traumatic Tricuspid Insufficiency: An Underdiagnosed Disease. \u003cem\u003eChest\u003c/em\u003e. 1987/09/01/ 1987;92(3):429-432. doi:https://doi.org/10.1378/chest.92.3.429\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJonjev ŽS, Milosavljević AM, Bjeljac I, Todić M, Koruga S. Tricuspid valve avulsion 3 years after blunt chest trauma. J Card Surg Dec. 2018;33(12):787\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/jocs.13939\u003c/span\u003e\u003cspan address=\"10.1111/jocs.13939\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan Son JA, Danielson GK, Schaff HV, Miller FA Jr. Traumatic tricuspid valve insufficiency: experience in thirteen patients. J Thorac Cardiovasc Surg. 1994;108(5):893\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlborzi Z, Zangouri V, Paydar S, et al. Diagnosing Myocardial Contusion after Blunt Chest Trauma. J Tehran Heart Cent Apr. 2016;13(2):49\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang Z, Yin K, Dong L, et al. Surgical management of traumatic tricuspid insufficiency. J Card Surg. 2017;32(6):342\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/jocs.13156\u003c/span\u003e\u003cspan address=\"10.1111/jocs.13156\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Tricuspid valve rupture, blunt cardiac injury, trauma, thoracic","lastPublishedDoi":"10.21203/rs.3.rs-4132276/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4132276/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eTricuspid valvular injuries are rare and often go undiagnosed, which can lead to right ventricular failure and death.\u003c/p\u003e\u003ch2\u003eCase Presentation:\u003c/h2\u003e \u003cp\u003eA 35-year-old female who presented after motor vehicle collision with multiple injuries was discovered to have a tricuspid valve rupture requiring valve replacement. In the case presented, the diagnosis was made with transthoracic echocardiography (TTE), however a subtler finding of new onset right bundle branch block was present during initial evaluation. The tricuspid valve rupture was managed with early valve replacement.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eAlthough rare, tricuspid valve injuries can occur after blunt chest trauma and can be difficult to diagnose. Early recognition and swift treatment can prevent deadly complications.\u003c/p\u003e","manuscriptTitle":"Tricuspid valve rupture after blunt thoracic trauma","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-22 18:38:30","doi":"10.21203/rs.3.rs-4132276/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-04-30T08:57:40+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-04-28T15:44:10+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-04-24T02:37:29+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-04-21T07:00:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-04-20T12:11:20+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-04-18T23:28:17+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-04-18T01:44:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"0e78dd35-6104-441e-b727-f3832725a965","date":"2024-04-15T08:33:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"ff538b2e-d191-45b9-b443-29d0081d3b10","date":"2024-04-14T23:09:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"1daf2861-eeb8-4dce-b5d7-27f2e86a5752","date":"2024-04-13T01:32:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"276abed3-6aa0-4922-9ff9-fcb1fcddb524","date":"2024-04-12T20:36:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"11d85064-edf1-4670-9b35-caec64d287da","date":"2024-04-12T18:07:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-04-12T16:59:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"f3c6a03c-66bc-4a0d-a3d4-1e03b2635b03","date":"2024-04-12T14:11:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"0bcf1640-359d-432c-97ac-25c730e1d71c","date":"2024-04-12T13:14:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"8d85d881-35f9-412f-af07-53dff8491c64","date":"2024-04-12T13:11:04+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-04-12T13:02:14+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-03-20T09:46:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-03-20T09:46:18+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Cardiothoracic Surgery","date":"2024-03-19T17:55:23+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a22e9a23-7f67-4575-85d3-57a9b9c0fb43","owner":[],"postedDate":"March 22nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2024-11-21T18:08:38+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-22 18:38:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4132276","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4132276","identity":"rs-4132276","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}