Fig. 1 The electrocardiogram showed complete right bundle branch block with posterior fascicular block. Fig. 2 The transthoracic see more echocardiography (A) and transesophageal echocardiography (B) showed prolapse of the septal (arrows) and anterior (arrow heads) tricuspid valve leaflet with large portions of the valve and the subvalvular appratus protruding into the … Fig. 3 The color-flow Doppler transthoracic echocardiography showed

severe tricuspid regurgitation (A). Peak velocity of tricuspid valve was 1.62 m/sec and right ventricular systolic pressure was 20.5 mmHg (B). Fig. 4 Inhibitors,research,lifescience,medical The transthoracic echocardiography after tricuspid valve repair showed satisfactory leaflet coaptation (A) and repaired papillary muscle (B). Discussion The incidence of blunt chest wall trauma and reported traumatic tricuspid regurgitation has been increasing during

the last decade.5) However, the diagnosis is difficult because this pathology slowly Inhibitors,research,lifescience,medical progress and its presentation can be atypical or asymptomatic, so its incidence rates may be underestimated.2),5),6) The most common mechanism of acute or subacute tricuspid regurgitation is an anteroposterior compression of the chest Inhibitors,research,lifescience,medical with a sudden increase in the right ventricular pressure during the end diastolic phase, when the main pulmonary vessels are compressed. This Inhibitors,research,lifescience,medical generates a marked traction on both valvular and subvalvular apparatus.5-8) The usual lesion observed at surgery is subvalvular rupture of the anterior papillary muscle.9) Alternatively, delayed tricuspid regurgitation may be due to papillary

muscle contusion with hemorrhage, inflammation, and late necrosis, leading to disruption over time.10) The timing of surgical intervention after traumatic tricuspid regurgitation is a subject Inhibitors,research,lifescience,medical of debate. The traditional indication for operation is symptomatic heart failure. But, severe tricuspid regurgitation can result in right ventricular myocardial PAK6 dysfunction and ventricular dilatation so that operation should be performed before development of myocardial dysfunction and symptom onset.11-13) Another factor to be considered in the optimal operation timing is contusion induced pulmonary hypertension in the acute event. In the treatment of tricuspid regurgitation with contusion induced pulmonary hypertension, postponing surgery to resolve pulmonary hypertension provides successful and durable repair.10) If valve is intact, tricuspid regurgitation is effectively correctable with reparative techniques in an early operation. Also it prevents right ventricular dysfunction.