Valve-Preserving Repair of Traumatic Tricuspid Regurgitation Using the Clover Technique. A Case Report: Clover Technique for Traumatic Tricuspid Repair

Abstract

Introduction: Traumatic tricuspid regurgitation (TR) is a rare complication of blunt chest trauma, often characterized by a long latent period before clinical presentation.

We report the case of a 38-year-old male presenting with severe TR 12 years after a motor vehicle accident. Intraoperative findings revealed a unique longitudinal fissure of the anterior leaflet extending from the annulus to the apex and anterior papillary muscle rupture.

We performed a complex reconstruction by incorporating the anterior papillary muscle into the leaflet, followed by the "Clover technique" to ensure central coaptation.

This hybrid approach allowed for a successful valve-preserving repair, restoring competence in a severely remodeled right ventricle.

Conclusion: Our case mirrors the complex pathology seen in the most difficult scenarios of the Alfieri series, where multiple lesions and RV deterioration preclude classic techniques. By incorporating the papillary muscle into the leaflet, we bridged a massive structural defect that would have otherwise necessitated valve replacement. The subsequent Clover repair provided a functional solution that neutralized the tethering of the posterior and septal leaflets.