Operative correction of traumatic tricuspid insufficiency

Between 1975 and 1991, 5 patients were operated for traumatic tricuspid insufficiency. The patients, all male, with the age at surgery of 15 to 61 years (mean 39 years), suffered previous nonpenetrating trauma to the chest 0.1 to 23 years (mean 13.2 years) earlier. Symptoms were known for 0 to 18 years (mean 10.5 years). The patients were in NYHA class II to IV (mean 2.9). Preoperative angiography showed moderate to severe tricuspid insufficiency. Mean right atrial pressure was 9.6 +/- 1.7 mm Hg and mean pulmonary artery pressure 14.0 +/- 2.4 mm Hg, the mean cardiothoracic ratio was 0.59 +/- 0.04, 4 patients were in sinus rhythm and 1 patient was in atrial fibrillation. Intraoperatively 4 patients showed rupture of the anterior chordae tendineae, 1 patient had multiple ruptures of the leaflets and the anterior papillary muscle, all tricuspid valves showed massive annular dilatation. A primary valvular reconstruction was undertaken in 3 patients of whom only 1 patient was successful in controlling tricuspid insufficiency. Finally, 4 tricuspid valves had to be replaced, 3 with a bioprosthetic and 1 with a mechanical valve. One patient died early, 2 patients died late during a total follow-up of 35.3 years after 7 and 9 years, 2 patients are alive 9 and 10 years after the operation and are presently in New York Heart Association class II to III and I. Traumatic tricuspid insufficiency is a rare event, but is not infrequently overlooked for a long period of time inspite of present symptoms. Results after operative correction seem to be comparable with the results in patients following tricuspid repair or replacement for functional and organic lesions.