Sammanfattning
BACKGROUND: Circulatory collapse during general anesthesia may have several causes. While the most common etiologies, such as misplaced endotracheal tube or anaphylaxis may be easy to discover, rarer causes may be difficult to identify.
CASE PRESENTATION: A man in his fifties with no known heart disease was to undergo scheduled orthopedic surgery. He had been in a car accident with substantial thoracic injuries 20 years prior, and had undergone surgery for colon cancer 15 years prior with no signs of relapse. While initiating general anesthesia during surgery, the patient showed signs of circulatory collapse and the operation was abruptly terminated. Comprehensive anamnesis revealed that the patient had suffered long standing and gradually increasing dyspnea which now disabled him considerably. Echocardiography disclosed a severe tricuspid valve regurgitation, most likely caused by the thoracic injuries 20 years earlier. With careful anesthesiologic planning, the patient underwent successful tricuspid valve surgery with implantation of a bioprosthesis.
INTERPRETATION: Delayed diagnosis of traumatic tricuspid valve regurgitation can be due to slow progression of symptoms and lack of knowledge of this disorder. However, the condition can lead to substantial symptoms and critical complications. The threshold for performing echocardiography after thoracic traumas should therefore be low.