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case_images: (A) Twelve-lead electrocardiogram prior the admission (2022). (B) Twelve-lead electrocardiogram at the admission in the emergency room showing a new complete right bundle branch block. (C) Transthoracic echocardiogram after surgical correction of atrial septal defect revealing a normal appearance of the tricuspid valve (2020).
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case_images: Her routine echocardiogram obtained before the horse kick showed normal RV dimensions without tricuspid valve abnormalities (Figure 1C; See SupplementaryVideo S1). A 12-lead electrocardiogram (ECG) showed sinus rhythm at 94 b.p.m. with a new complete right bundle branch block (QRS duration at 142 ms), which was absent on the previous ECG taken before the horse kick (Figure 1A and B).
case_images: (A-C) Transthoracic echocardiogram showing severe tricuspid regurgitation due to the rupture of the anterior papillary muscle. Arrows indicating the flail leaflet.
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case_images: A transthoracic echocardiogram (TTE) was performed the day after admission and showed massive (effective regurgitant orifice area 1.8 cm2, vena contracta 14 mm), central, holosystolic tricuspid regurgitation due to the rupture of the anterior papillary muscle, with preserved RV function [fractional area change (FAC) 45.6%] and no other complications (Figure 2; See SupplementaryVideos S2-S5).
case_images: (A, B) Preoperative transoesophageal echocardiogram images.
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case_images: After preoperative evaluation, she was scheduled for elective tricuspid valve repair (reimplantation of the anterior papillary muscle with neochordae and tricuspid annuloplasty) 3 weeks after the horse kick (Figures 3 and 4; See SupplementaryVideos S6-S8).
case_images: (A-E) Illustrations of the tricuspid valve repair surgery.
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case_images: After preoperative evaluation, she was scheduled for elective tricuspid valve repair (reimplantation of the anterior papillary muscle with neochordae and tricuspid annuloplasty) 3 weeks after the horse kick (Figures 3 and 4; See SupplementaryVideos S6-S8).
case_images: Key events timeline. ASD, atrial septal defect; ECG, electrocardiogram; EROA, effective regurgitant orifice area; NYHA, New York Heart Association; RBBB, right bundle branch block; RV-FAC, right ventricular fractional area change; TAPSE, tricuspid annular plane systolic excursion; TTE, transthoracic echocardiogram; TOE, transoesophageal echocardiogram; TR, tricuspid regurgitation.
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case_images: However, at the patient's request, the operation was postponed to 9 weeks after diagnosis (Figure 5).