INTRODUCTION:

Tricuspid insufficiency (TI) is thought to be a rare complication of blunt,nonpenetrating chest trauma.The right ventricle (RV) is immediately behind the sternum,predisposing it to an anteroposterior compression type of injury,especially during the end diastolic phase.

CASE DESCRIPTION:

A previously healthy 39-year-old male without cardiac history was admitted to the emergency room with symptoms of heart failure and atrial flutter.Transthoracic echocardiogram showed significant tricuspid regurgitation, with an image suggestive of chordae rupture related to the anterior leaflet,with significant enlargement of the right chambers (right atrium indexed volume 115 ml/m²),moderate RV systolic dysfunction.After clinical stabilization, a history of high-energy automobile trauma occurred 20 years ago was identified,which resulted in traumatic brain injury and blunt abdominal trauma,requering abdominal surgeries; did not have any cardiovascular symptoms.Since then,he has not performed any cardiovascular follow-up.However, about three years ago,after starting to practice intense sports,he noticed of fatigue and dyspnea.He noticed progression of symptoms, seeking care in the emergency room with dyspnea on minimal exertion, palpitations and chest pain.In the heart team it was indicated surgical correction for severe TI.In the intraoperative,rupture of the chordae was observed, with calcification of the related papillary muscle and significant dilation of the tricuspid ring (60 mm);he was underwent valve replacement for a biological prosthesis in the tricuspid position.Postoperative echocardiogram showed the prosthesis in tricuspid position without reflux and maximum gradient of 8 mmHg.

CONCLUSION:

We report a case of traumatic TI,manifesting symptoms 20 years after the trauma.The interval between the traumatic event and the appearance of symptoms is variable,possibly due to the variability of possible associated valve lesions.While papillary muscle rupture is associated with more severe and acute symptoms (weeks to months), chordae rupture more commonly causes a slower course -10 to 25 years.The timing and appropriate treatment of traumatic TI depends on the natural course of the disease.Most cases do not require surgical intervention in the immediate period after the event. However,in the medium and long term,surgical correction of the tricuspid valve -by replacement or valve repair- is indicated to improve symptoms and avoid permanent impairment of the RV.