Atrial Septal Rupture, Flail Tricuspid Valve, and Complete Heart Block Due to Nonpenetrating Chest Trauma

Diagnosis and management of blunt cardiac injury: What you need to know

ABSTRACT

Blunt cardiac injury (BCI) encompasses a wide spectrum, from occult and inconsequential contusion to rapidly fatal cardiac rupture. A small percentage of patients present with abnormal electrocardiogram or shock, but most are initially asymptomatic. The potential for sudden dysrhythmia or cardiac pump failure mandates consideration of the presence of BCI, including appropriate monitoring and management. In this review, we will present what you need to know to diagnose and manage BCI.

Different types of tricuspid flail: Case reports and review of the literature

Tricuspid regurgitation (TR) is a common Doppler echocardiographic finding resulting from either intrinsic valve abnormalities or functional malcoaptation of structurally normal valves. TR caused by flail leaflets is most often post-traumatic, is caused by endocarditis or is a consequence of a myxomatously degenerated valve. The clinical presentation is severe and is characterized by excess mortality and high morbidity. Flail leaflets are reliably diagnosed using 2-dimensional and 3-dimensional echocardiography.

Acquired Gerbode defect and third-degree atrioventricular block secondary to vehicular trauma in a dog

OBJECTIVE

To describe a case of traumatically acquired left ventricular to right atrial communication (Gerbode defect), atrial septal defect (ASD), and third-degree atrioventricular block (AVB) necessitating permanent pacemaker placement in a dog.

CASE SUMMARY

A 1.5-year-old neutered male Newfoundland dog was struck by a car and was referred for further evaluation and treatment of hemoabdomen. Persistent third-degree AVB, a right-sided cardiac murmur and right-sided congestive heart failure (CHF) were identified, and echocardiographic examination revealed a type-A Gerbode defect and ASD. Pimobendan, furosemide, and enalapril therapies were initiated for treatment of CHF. Persistent AVB eventually necessitated permanent pacemaker implantation. Initial attempts at minimally invasive occlusion of the Gerbode defect were unsuccessful; however the dog continues to do well clinically on chronic cardiac medications.

NEW OR UNIQUE INFORMATION PROVIDED

To our knowledge, an acquired Gerbode defect secondary to trauma with associated ASD, CHF, and third-degree AVB necessitating permanent pacemaker therapy have not yet been reported in the veterinary literature. The extended survival and follow-up available on this patient postpacemaker implantation also documents that longer term survival is possible with this defect.

Fossa ovalis tear causing right to left shunting in a Cavalier King Charles Spaniel

Left atrial tear is an infrequent sequela of severe mitral regurgitation due to myxomatous mitral valve degeneration. Interatrial septal tear due to mitral regurgitation causing a left-to-right shunt is uncommon. Right to left shunting secondary to acute interatrial septal tear is very rarely reported in the human literature, and has not been reported in the veterinary literature in a dog. This case describes the clinical, radiographic, echocardiographic, gross pathologic, and histopathologic features of a dog presented in acute respiratory distress secondary to acute onset right to left shunting through the interatrial septum. This was later documented to be due to a tear in the septum secondary to tricuspid regurgitation and pulmonary hypertension. The presence of an acquired right to left shunting atrial septal defect is of clinical and prognostic significance, and should be considered in cases of acute respiratory distress.