BACKGROUND: Delayed traumatic cardiac rupture complicated by secondary tricuspid chordae tendineae rupture is an exceedingly rare clinical entity. We report this case to describe the temporal sequence of events from blunt myocardial contusion to left ventricular aneurysm formation and rupture, followed by secondary tricuspid chordae tendineae rupture. While the precise mechanism linking these events remains to be determined, we propose a potential pathophysiological connection.

CASE REPORT: A patient presented with rupture of a posterior left ventricular aneurysm 54 days after a fall from a height. The patient was emergently placed on venoarterial extracorporeal membrane oxygenation (VA-ECMO) for circulatory support and subsequently underwent surgical repair of the aneurysm. Postoperative echocardiography revealed new-onset tricuspid chordae tendineae rupture, prompting elective mechanical tricuspid replacement. Histopathological examination of resected valve tissues revealed chronic degenerative changes. To our knowledge, this is the first report documenting this temporal sequence of delayed left ventricular aneurysm rupture followed by tricuspid chordal rupture after surgical repair.

CONCLUSIONS: This case highlights the importance of continued clinical and echocardiographic vigilance after severe blunt cardiac injury, particularly for detecting late-emerging structural complications such as aneurysm formation and valvular dysfunction. It also illustrates the potential utility of VA-ECMO as a critical bridging strategy to stabilize patients with traumatic cardiac rupture before surgical repair. The observed temporal association between aneurysm repair and subsequent tricuspid chordal rupture is noted, though the exact causal relationship and underlying mechanism remain uncertain.

Keywords: Extracorporeal Membrane Oxygenation, Heart Aneurysm, Heart Injuries, Heart Rupture, Tricuspid Valve Prolapse