Tricuspid valve replacement for cardiogenic shock after acute right ventricular infarction

A 66-year-old man had an acute inferior wall myocardial infarction complicated by hypotension, high-grade atrioventricular block, and distended neck veins, suggesting associated right ventricular infarction. He failed to respond to volume loading, intra-aortic balloon counterpulsation, and pharmacologic afterload reduction. Cardiac catheterization five days after the infarction disclosed severe tricuspid regurgitation and a hemodynamic pattern resembling pericardial constriction. Emergency tricuspid valve replacement was dramatically successful.