Robotic Repair of Post-Traumatic Tricuspid Regurgitation: a Case Report
Emiliano Navarra, Gebrine El Khoury, Laurent De Kerchove, Philippe Noirhomme.
Cliniques Universitaires St. Luc – UcL – Brussels , Belgium, Brussels, Belgium.
Patient Demographics: Post-traumatic tricuspid regurgitation is a rare complication of blunt chest trauma. The most frequently reported lesions are: chordal ruptures, ruptures of the anterior papillary muscle and leaflet tears. Most commonly is involved the anterior leaflet. Here, we report a case of a 31-year-old female patient addressed to our institution for a post-traumatic severe tricuspid regurgitation.
Relevant History: The patient was admitted in our department few months after have been injured from a car accident. In the acute phase of the injury, the tricuspid valve lesion remained undetected. After few months the patient start to exhibit symptoms and signs of right heart failure.
Pre-Operative Plan: Echocardiography demonstrated a severe tricuspid regurgitation due to the prolapse of the anterior leaflet, associated to the partial rupture of the anterior papillary muscle.
Discussion of what was actually done and the challenges, deaths and complications encountered. (Unless case is still pending): The patient underwent to a robotic repair of the tricuspid valve consisting in the reconstruction of the ruptured papillary muscle to correct the prolapse, associated with neochordae, to ensure the support for the leaflet, and followed by the annuloplasty ring implantation. Robotic approach to the tricuspid valve allow to associate the advantage of the minimal invasive techniques with an excellent exposure of the leaflets and the sub-valvular structures, a meticulous analysis of the lesions responsible for the regurgitation and the possibility to perform complex tricuspid repair. Post repair TEE showed a continent tricuspid valve with no residual prolapse. Post-operative course was uneventful. The patient was discharged at fifth post-operative day. Echocardiography, at 1-year follow-up, showed an optimal functional result with no residual regurgitation and prolapse.
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