A 39-year-old man was examined for progressive fatigue nine months after suffering blunt chest trauma. Jugular venous distention with a C-V wave, a right ventricular lift, and a tricuspid insufficiency murmur were noted. A chest roentgenogram showed cardiomegaly and an ECG demonstrated a right bundle-branch block. The M-mode echocardiogram of the right ventricle (left panel) and of the tricuspid valve (right panel) is shown in Fig 1.
What is your diagnosis?
Cross-sectional echocardiogram, cardiac catheterization, and subsequent surgical repair confirmed the diagnosis. The M-mode echocardiogram of the right ventricle is taken at the level of the tricuspid valve. There is mild right ventricular enlargement with paradoxic septal movement compatible with right ventricular volume overload (Fig 1, left panel). Diastolic fluttering of the tricuspid septal leaflet (Fig 1, downward arrow, right panel) is consistent with increased transvalvular flow. Wide excursion and diastolic notching of the anterior tricuspid leaflet (Fig 1,
Bardy GH, Talano JV. Right Ventricular Failure in a Young Man After Chest Trauma. Arch Intern Med. 1982;142(3):615-616. doi:10.1001/archinte.1982.00340160195033