Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Repair of Ruptured Papillary Muscle of the Tricuspid Valve as a Cause of Tricuspid Insufficiency Following Blunt Chest Trauma

흉부 둔상후 삼첨판막 폐쇄부전을 유발한 삼첨판막 유두근 파열의 치료

  • Bang, Jung-Hee (Department of Thoracic and Cardiovascular Surgery, Dong-A Medical Hospital, College of Medicine, Dong-A University) ;
  • Woo, Jong-Soo (Department of Thoracic and Cardiovascular Surgery, Dong-A Medical Hospital, College of Medicine, Dong-A University) ;
  • Choi, Pill-Jo (Department of Thoracic and Cardiovascular Surgery, Dong-A Medical Hospital, College of Medicine, Dong-A University) ;
  • Park, Kwon-Jae (Department of Thoracic and Cardiovascular Surgery, Dong-A Medical Hospital, College of Medicine, Dong-A University) ;
  • Jeong, Sang-Seok (Department of Thoracic and Cardiovascular Surgery, Dong-A Medical Hospital, College of Medicine, Dong-A University) ;
  • Lee, Jung-Hoon (Department of Thoracic and Cardiovascular Surgery, Dong-A Medical Hospital, College of Medicine, Dong-A University)
  • 방정희 (동아대학교 의과대학 동아대학교병원 흉부외과학교실) ;
  • 우종수 (동아대학교 의과대학 동아대학교병원 흉부외과학교실) ;
  • 최필조 (동아대학교 의과대학 동아대학교병원 흉부외과학교실) ;
  • 박권재 (동아대학교 의과대학 동아대학교병원 흉부외과학교실) ;
  • 정상석 (동아대학교 의과대학 동아대학교병원 흉부외과학교실) ;
  • 이정훈 (동아대학교 의과대학 동아대학교병원 흉부외과학교실)
  • Received : 2010.02.05
  • Accepted : 2010.04.20
  • Published : 2010.08.05
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Abstract

A 47-year-old man presented with complaints of chest pain and dyspnea caused by deceleration injury due to an automobile accident. Systolic cardiac murmur was audible at the right sternal border. An electrocardiogram showed sinus tachycardia. Transthoracic echocardiography revealed a flailing anterior leaflet of the tricuspid valve, papillary muscle rupture, and severe valve insufficiency. Rupture of papillary muscle of the anterior leaflet and chordae tendineae of the posterior leaflet were confirmed by right atrial incision under routine cardiopulmonary bypass. Artificial chordae tendineaes were implanted between the anterior and posterior leaflet and papillary muscles in the right ventricles. De-Vega annuloplasty was also added. This is a very rare case in which a surgery was done for tricuspid valve regurgitation caused by post-traumatic papillary muscle rupture.

47세 남자 환자가 교통사고로 인한 감속 손상후 흉부 통증 및 호흡곤란을 주소로 내원하였다. 청진시 우 흉골연에서 수축기 심잡음이 들렸고 심전도에서는 분당 120∼130회의 동빈맥을 보였다. 경흉부 심장 초음파에서 삼첨판막의 전엽이 동요하는 형태를 보였고 유두근의 파열과 함께 심한 판막 폐쇄 부전이 관찰되었다. 수술은 통상적인 심폐기하에서 우심방절개를 통해 접근하여, 전엽의 유두근과 후엽의 건삭이 파열되어 있는 것을 확인하였다. 전엽과 후엽에 각각 우심실내의 유두근으로 새로운 인공 건삭을 조성하였다. 또한 De-Vega 판륜 성형술을 병행하여 시행하였다. 저자들은 매우 드물게 발생한다고 알려져 있는 외상후 유두근 파열로 인한 삼첨판막의 기능부전의 수술을 경험하였기에 문헌고찰과 함께 보고하는 바이다.

Keywords

References

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