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Severe tricuspid regurgitation following a stab to the heart
  1. N Howell,
  2. R Steeds,
  3. D Pagano

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A 28 year old man sustained an isolated stab injury to the left third intercostal space in the mid clavicular line. The weapon was reported to be a kitchen knife 12 cm in length. A transthoracic echocardiogram revealed a pericardial effusion. He was transferred to our department and was taken to theatre for emergency surgery. A median sternotomy was performed. An entry wound was found over the anterior aspect of the right ventricular outflow tract, and an exit wound on the inferior surface of the right ventricle near the atrioventricular groove (panel A). Cardiopulmonary bypass was instituted because of haemodynamic instability. Both ventricular tears were repaired with interrupted 4′0 polypropylene sutures. An intraoperative transoesophageal echocardiogram was performed following weaning from bypass to assess intracardiac structures. This revealed severe regurgitation through the anterior leaflet of the tricuspid valve (panels B and C). Bypass was re-instituted with bicaval cannulation. The right atrium was opened directly on beating heart and a defect confirmed in the tricuspid leaflet. This was repaired with interrupted 5′0 polypropylene sutures. The patient made an uneventful recovery and was discharged home.

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