# Successful repair of traumatic tricuspid regurgitation with concomitant atrial septal perforation and right ventricular pseudoaneurysm: a case report

## TL;DR

A rare case of traumatic tricuspid regurgitation combined with heart wall and atrial injuries was successfully repaired surgically after a delayed intervention.

## Contribution

This case report presents a rare and complex traumatic cardiac injury successfully managed with surgical repair.

## Key findings

- Traumatic tricuspid regurgitation can occur due to papillary muscle rupture and atrial septal perforation.
- Delayed surgical repair can effectively manage traumatic tricuspid valve injuries when medical treatment stabilizes the patient.
- Combining annuloplasty, chordae reconstruction, and papillary muscle repair can achieve complete control of tricuspid regurgitation.

## Abstract

Valvular injuries in chest trauma mostly affect the aortic and mitral valves, but traumatic tricuspid regurgitation (TR) remains rare. This report describes the successful repair of traumatic TR secondary to papillary muscle rupture complicated with right ventricular (RV) free wall injury and atrial septal perforation.

A 50-year-old male suffered blunt chest trauma from a tree fall, leading to multiple fractures, mediastinal hematoma, and hemoperitoneum caused by splenic bleeding. Given that heart failure worsened eventually, echocardiography was conducted on day 7, showing significant TR resulting from leaflet prolapse caused by papillary muscle rupture with concomitant 4.8 mm atrial septal perforation and focal RV free wall thinning. Nonetheless, the heart failure was responsive to medical treatment. The patient was then scheduled for surgery 1 month later. The atrial septal defect was closed via direct suture closure. The RV free wall injury presented with scarring and did not require repair. The tricuspid valve repair included suturing the ruptured medial papillary muscle to the RV wall, reconstructing the ruptured posterior leaflet chordae with prosthetic chordae, and securing an annuloplasty ring. Consequently, TR was completely controlled.

Traumatic tricuspid valve injuries are rare. The optimal timing of surgery for traumatic TR remains controversial. However, early diagnosis and intervention are recommended to prevent progressive RV dysfunction and improve the success of tricuspid valve repair.

The online version contains supplementary material available at 10.1186/s44215-025-00211-8.