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A 28-year old male sustaining a penetrating injury to the subxiphoid area presented to the emergency department fully conscious and haemodynamically stable. The CT scan revealed a localized infero-posterior pericardial collection. Emergency surgery was planned to evacuate the collection and assess the extent of injury. Intraoperative transoesophageal echocardiogram demonstrated severe tricuspid regurgitation due to transection of the papillary muscle, as well as a ventricular septal defect. Tricuspid repair with reconstruction of the papillary muscle, closure of the ventricular septal defect (VSD) and the right ventricular laceration was performed. Mitral regurgitation secondary to chordae rupture was identified following de-airing maneuvers, and subsequently underwent repair. Traumatic VSD and lesions of the mitral and tricuspid valves causing insufficiency have been reported before. They have been described in isolation or as combination of two lesions but never the combination of the three of them as described in this case.

Ventricular septal defect and tricuspid and mitral valve insufficiency caused by penetrating trauma