[Outcome of traumatic tricuspid insufficiency, treated surgically. Apropos of 9 cases]

Between 1983 and 1992, 9 patients with traumatic tricuspid regurgitation underwent surgical correction. The population consisted of young male adults (mean age 39 years). The trauma was usually due to a road traffic accident (n = 6). The mean interval to diagnosis was long (11 years). Echocardiography was diagnostic and showed the mechanisms. The usual lesion observed at surgery was subvalvular rupture of the anterior papillary muscle (n = 5). Surgery consisted of valve repair with annuloplasty and eight valve replacements for chronic retractile lesions. Six patients are still being followed up (average 7 years). There were no peroperative complications. Two patients underwent a second valve replacement for degeneration of a bioprothesis. Conduction defects requiring permanent cardiac pacing were not uncommon (n = 3) The delay before diagnosis may be explained by the diversity of lesion of the tricuspid valve, associated cardiac disease and the requesting of echocardiography. Surgical indications are mainly based on clinical signs. Even if long-term results are satisfactory, earlier diagnosis would probably allow more conservative surgery with preservation of right ventricular geometry and function.