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Eastern Cardiothoracic Surgical Society

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Firework to the Chest: A Case of Tricuspid Anterior Leaflet Flail After Blunt Trauma
Donna K. Phan1, Anna Liveris2, Jody M. Kaban2
1Montefiore Medical Center, Albert Einstein School of Medicine, Bronx, NY, USA, 2Jacobi Medical Center, Albert Einstein School of Medicine, Bronx, NY, USA

Background: We present an uncommon case study of a patient who sustained a tricuspid valve injury after severe blunt trauma to the chest caused by firework. METHODS: Case report. RESULTS: A 25-year-old otherwise healthy male was brought in by EMS after a firework exploded in close proximity to his right chest. On arrival, the patient’s skin was intact, but there was bruising and crepitus over the right thoracoabdominal region. He had dyspnea and decreased breath sounds, and a chest-tube confirmed hemothorax. The patient became hemodynamically unstable in the trauma bay, and was taken emergently to the OR. He underwent right middle and lower lobectomy due to extensive pulmonary lacerations. No pericardial effusion or obvious external injury to the heart was appreciated. Additional injuries included multiple rib fractures, left pulmonary contusions, and a liver laceration. Post-operatively in the ICU, the patient developed signs of pulmonary hypertension, and a transesophageal echo also revealed moderate tricuspid regurgitation with anterior leaflet flail. The patient was treated with supportive measures including nitric oxide, and he was successfully extubated 23 days after his initial injury. Several days later the patient was discharged home. At follow-up, he felt well with mild shortness of breath. CONCLUSIONS: Blunt trauma is a rare cause of tricuspid valve injury. Only 33 cases are reported in the literature, the majority of which are due to motor vehicle accidents. Most, like ours, are treated conservatively. We report the only case of tricuspid valve injury secondary to a firework blast.


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