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A Journal on Forensic Medicine
Minerva Medicolegale 2004 June;124(2):57-62
Tricuspid insufficiency due to nonpenetrating chest trauma. A case report
De Battisti Z., Tirriozo S. F.
Cardiac injuries frequently occur after blunt thoracic trauma; they vary from simple myocardial contusion to more severe damage of intracardiac structures. However, lesions of the cardiac valves resulting in clinically significant incompetence are uncommon and have only been observed in approximately 5% of necroscopy autopsies carried out subjects who died after nonpenetrating trauma to the heart. A case of a 48-year-old man involved in a car accident is described. A few days later he was admitted to a hospital after onset of dyspnea, cyanosis, palpitations and a control echocardiographic study (transesophageal echocardiography and transthoracic echocardiogram) showed interatirial defect and tricuspid insufficiency secondary to nonpenetrating chest trauma. The patient was submitted to surgery: a patent foramen ovale was closed by direct suture; the anterior leaflet of the tricuspid valve was found to be detached from the papillary muscles due to rupture of several chordae tendineae and appeared completely retracted. Therefore, repair was not feasible and the valve was replaced. In conclusion, the authors discuss the main problems facing a medicolegal diagnosis which include a careful analysis of the accident, the causal connection between trauma and diagnosis, with a series of examinations including, topographic or chronologic classical criteria, the final evaluation of permanent sequelae, and medicolegal observations in a private personal accident-insurance field.