Case Reports Korean Circulation J 1999;2910:1133-1137 흉부둔외상후 8 년뒤에증상이발현된삼첨판폐쇄부전 1 례 김연중 문건식 김재성 황흥곤 Tricuspid Insufficiency Detected 8 Years Later Following a lunt Chest Trauma Yeoun Jung Kim, MD, Keon Sik Moon, MD, Jae Sung Kim, MD and Hweung Kon Hwang, MD Department of Internal Medicine, Sejong General Hospital, Puchun, Korea STRCT Post-traumatic tricuspid insufficiency is a rare condition and may be clinically silent and imprecise. The diagnosis may be difficult when it progreses slowly and other acute lesions exist concomittantly. Two-dimenstional Doppler echocardiography appears to be an essential procedure in diagnosting the rupture of chordae tendineae or papillary muscle following traumatic injury. We report a case of tricuspid insufficiency of which symptom developed 8 years later following a blunt chest trauma. The patient was operated by tricuspid vlave repair with chordal replacement and ring annuloplasty successfully. We would like to emphasize that patients sustaining major thoracic trauma should be carefully examine for possible blunt chest trauma including cardiac valve rupture or tear. Korean Circulation J 1999;2910:1133-1137 KEY WORDSlunt chest trauma Tricuspid insufficiency Tricuspid valve repair Doppler echocardiography. 서 론 증례 1133
으며 당시 심장 병변은 없었다고 한다. 2년전부터 간헐 75회로 규칙적이었고 체온은 37, 호흡수는 분당 24 적으로 운동시 호흡곤란과 피로감이 발생하였으며 내 회였다. 경정맥 울혈이 관찰되었고 좌측 흉골하연을 따 원 7개월 전에는 상기도 감염후 호흡곤란(NYHⅡ)과 라 grade Ⅲ/Ⅵ의 범수축기잡음이 청취되었으며 흡기 하지부종이 발생되었으나 특별히 치료하지 않고 지내시 시 강도가 약간 증가하였다. 폐야 에서 수포음은 들리 다 2개월전부터 저녁에 특히 심한 기침과 호흡곤란 지 않았다. 간은 늑골하로 1횡지 촉지되었고 사지부종 (NYHⅢ)으로 타병원에서 심부전 진단 하에 입원치 이 관찰되었다. 검사소견 말초혈액도말검사와 소변검사는 정상이 료후 증상 호전되었으나 퇴원후에도 상기증상 계속되 어 본원에 내원하였다. 었고 ST/LT 44/36 IU/L, total bilirubin 0.9 mg/ 과거력 및 가족력 특이 소견이 없었다. dl, LP 283 IU/L,기타 생화학적 검사는 정상이었다. 계통적 문진 운동시 호흡곤란, 간헐적 사지부종, 저 흉부 X-선상 심비대가 있었으며(Fig. 1), 심전도 검 녁에 특히 심한 기침 등을 호소였고 그 외 특이 소견은 사에서는 완전 우각블록(complete R)의 소견을 없었다. 보였다. 심초음파 검사 우심방과 우심실이 현저하게 커져 있 진찰 소견 혈압은 130/90 mmhg, 심박동은 분당 Fig. 1. preoperative chest P shows cardiomegaly. postoperative chest P shows normalized heart size. Fig. 2. Transthoracic echocardiography (parasternal short axis view in systole) shows flail of anterior tricuspid leaflet with ruptured papillary muscle head moving into the right atrium, and total loss of its coaptation with the other leaflets. In same view, color Doppler echocardiography shows severe tricuspid regurgitation. 1134 Korean Circulation J 1999;29(10):1133-1137
Fig. 3. Right atrial pressure pulse shows characteric of tricuspid insufficiencythe X descent was interrupted by a large n wave, with reached a peak equal to 16 mmhg. 경과및치료 Fig. 4. Transthoracic echocardiography apical 4 chamber shows severe tricuspid regurgitation preoperatively. mild tricuspid regurgitation postoperatively. 1135
고찰 1136 중심단어 Korean Circulation J 1999;2910:1133-1137
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