But it has been reported with increasing frequency, which may be due to the increase in the number of high speed automobile accidents and advances in echocardiography.5) In most reported cases, traumatic Ruxolitinib cost tricuspid regurgitation was frequently missed in emergency department. Although optimal operation timing is important, it is not uncommon to be Inhibitors,research,lifescience,medical diagnosed with tricuspid valve injury after several months to years.1-3),6) Here, we report a case of successful repair of tricuspid valve after early detection of severe

traumatic regurgitation following blunt chest trauma. Case A 19-year-old man, with no past and familial history of heart disease, was brought to the emergency department following a motorcycle accident in

which his chest hit the steering wheel with considerable force. He presented left knee, chest and abdominal pain. The patient’s vital signs were temperature Inhibitors,research,lifescience,medical 36.5℃, heart rate 105 beats per minute, respiration rate 20 per min, blood pressure 100/60 mmHg, and pulse oximetry 98% on room air. On the initial physical examination, a pansystolic murmur was heard along the lower left sternal border with inspiratory accentuation, but signs of right heart failure Inhibitors,research,lifescience,medical were not detected. Chest radiograph was normal. Electrocardiogram showed complete right bundle branch block with left posterior fascicular block (Fig. 1). Results of laboratory tests were notable for Inhibitors,research,lifescience,medical elevated cardiac biomarker, creatine kinase myocardial band isoenzyme was 144.1 ng/mL, troponin I was 13.88 ng/mL. Echocardiography was performed for evaluation of chest pain and elevated cardiac biomarker. A flail of the septal and

anterior tricuspid leaflet was present and rupture of the papillary muscle was suspected on transthoracic echocardiography (Fig. 2A). Although Inhibitors,research,lifescience,medical all cardiac structures were identified on transthoracic echocardiography, we performed transesophageal echocardiography to delineate exact anatomy of subvalvular structure. It confirmed prolapse of the septal and anterior tricuspid valve leaflet with large portions of the valve and the subvalvular apparatus protruding into the right atrium indicating rupture of both anterior and posterior papillary muscles (Fig. 2B). Color-flow Doppler echocardiography shows severe (-)-p-Bromotetramisole Oxalate tricuspid valve regurgitation (Fig. 3A). Peak velocity of tricuspid valve was 1.62 m/sec and estimated right ventricular systolic pressure was 20.5 mmHg (Fig. 3B). We decided to repair tricuspid valve and referred to thoracic surgery department. Intraoperative findings confirmed the echocardiographic diagnosis of papillary muscle rupture. Tricuspid valve repair was performed with reimplantation of the ruptured papillary muscle and a ring annuloplasty. Postoperative echocardiography showed satisfactory leaflet coaptation (Fig. 4A) and repaired papillary muscle (Fig. 4B). Only mild tricuspid regurgitation remained.