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Tinzin L, Gao X, Li H, Zhao S. Sudden death associated with delayed cardiac rupture: case report and literature review. Front Cardiovasc Med 2024; 11:1355818. [PMID: 38682101 PMCID: PMC11045948 DOI: 10.3389/fcvm.2024.1355818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/03/2024] [Indexed: 05/01/2024] Open
Abstract
Cardiac injury plays a critical role in the process of thoracic trauma-related fatal outcomes. Historically, most patients who suffer a cardiac rupture typically die at the scene of occurrence or in the hospital, despite prompt medical intervention. Delayed cardiac rupture, although rare, may occur days after the initial injury and cause sudden unexpected death. Herein, we present the clinical details of a young man who suffered a chest stab injury and recovered well initially, but died days later due to delayed cardiac rupture. The forensic autopsy confirmed delayed cardiac rupture as the cause of death. We also reviewed previous similar reports to provide suggestions in such rare cases in clinical and forensic practice.
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Affiliation(s)
- Lopsong Tinzin
- Sichuan Ding Cheng Judical Expertise Center, Chengdu, China
| | - Xuefei Gao
- Department of Pediatric Surgery and Urology-Andrology, First Moscow State Medical University named after Sechenov, Moscow, Russia
| | - Hui Li
- Sichuan Ding Cheng Judical Expertise Center, Chengdu, China
| | - Shuquan Zhao
- Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China
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Parentic M, Podolski E, Korda M, Katic B, Kajs FJ, Krzelj K, Belina D, Gasparovic H, Tokic T, Duric Z. Penetrating injury to the left ventricle caused by attempted suicide-a case report. J Surg Case Rep 2024; 2024:rjae159. [PMID: 38505331 PMCID: PMC10948745 DOI: 10.1093/jscr/rjae159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 02/22/2024] [Indexed: 03/21/2024] Open
Abstract
Penetrating cardiac injuries are rare but are one of the most urgent emergencies because they require early intervention in order to prevent death. The mortality rate of such injuries, including pre-hospitalization deaths, goes up to 90%. The most commonly injured heart chamber is the right ventricle since it takes over half of the anterior thoracic wall. The left ventricle is injured less often, but these patients usually have worse prognoses and higher mortality rates because such injuries lead to hemodynamic instability faster. We present a unique case of a suicide attempt in which the patient stabbed himself with a knife, penetrated the left ventricle, and survived even though he transected the second diagonal branch of the left anterior descending coronary artery and pulled the knife out of his chest.
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Affiliation(s)
- Mara Parentic
- University of Zagreb, School of Medicine, Zagreb 10000, Croatia
| | - Eva Podolski
- University of Zagreb, School of Medicine, Zagreb 10000, Croatia
| | - Marin Korda
- University of Zagreb, School of Medicine, Zagreb 10000, Croatia
| | - Borna Katic
- University of Zagreb, School of Medicine, Zagreb 10000, Croatia
| | - Fran Juraj Kajs
- University of Zagreb, School of Medicine, Zagreb 10000, Croatia
| | - Kristina Krzelj
- Department of Cardiac Surgery, University Hospital Center Zagreb, Zagreb 10000, Croatia
| | - Drazen Belina
- Department of Cardiac Surgery, University Hospital Center Zagreb, Zagreb 10000, Croatia
| | - Hrvoje Gasparovic
- Department of Cardiac Surgery, University Hospital Center Zagreb, Zagreb 10000, Croatia
| | - Tomislav Tokic
- Department of Cardiac Surgery, University Hospital Center Zagreb, Zagreb 10000, Croatia
| | - Zeljko Duric
- Department of Cardiac Surgery, University Hospital Center Zagreb, Zagreb 10000, Croatia
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Alfraidy D, Aldarsouni FG, Dagestani H, Al Ramahi GZ. An Emergency Adaptation of Anterolateral and Clamshell Thoracotomy for Blunt Traumatic Right Atrial Rupture: A Case Report. Cureus 2023; 15:e49208. [PMID: 38143623 PMCID: PMC10739582 DOI: 10.7759/cureus.49208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 12/26/2023] Open
Abstract
The high mortality rate of blunt cardiac injuries is primarily due to the condition's severity and the challenges associated with pre-hospital survival. The absence of definitive diagnostic modalities necessitates prompt and adaptable surgical intervention. We present an 18-year-old male who sustained a right atrial blunt traumatic cardiac rupture following a motor vehicle collision. Despite initial stabilization with blood products and vasopressors and the necessitated emergent surgical exploration, the case required various surgical techniques, including anterolateral followed by an extension to a clamshell thoracotomy and laparotomy to manage the complex cardiac rupture and associated injuries. Furthermore, it underscores the critical nature of surgical incision in such patients and its impact on the overall prognosis. The successful outcome, highlighted by intraoperative decision-making and proper postoperative care, demonstrates that with timely and adaptable surgical approaches, even the most severe cases of traumatic blunt cardiac ruptures can be managed effectively.
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Affiliation(s)
- Doaa Alfraidy
- Department of Surgery, King Saud University Medical City, Riyadh, SAU
| | | | - Hatoon Dagestani
- Department of Surgery, King Saud University Medical City, Riyadh, SAU
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Isaza-Restrepo A, Donoso-Samper A, Benitez E, Martin-Saavedra JS, Toro A, Ariza-Salamanca DF, Arredondo N, Molano-Gonzales N, Pinzon-Rondon AM. Retrospective analysis of 261 autopsies of penetrating cardiac injuries with emphasis on sociodemographic factors. Sci Rep 2023; 13:11563. [PMID: 37463948 DOI: 10.1038/s41598-023-38756-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 07/14/2023] [Indexed: 07/20/2023] Open
Abstract
Penetrating cardiac injuries (PCIs) are highly lethal and several factors are related to its incidence and mortality. While most studies focus on characterizing patients who arrived at a medical facility alive and exploring the relationship between the degree of heart compromise and mortality, our study delved deeper into the topic. This study analyzed 261 autopsy reports from 2017 in Bogotá, Colombia, and characterized the factors surrounding PCI incidence and mortality while emphasizing the role of sociodemographic variables. Of these cases, 247 (94.6%) were males with a mean age of 29.19 ± 9.7 years. Weekends, holidays, and late hours had the highest incidence of PCIs. The victims' deaths occurred at the scene in 66 (25.3%) cases, and 65.1% of the victims died before receiving medical care. Upon admission, patients with vital signs were more likely to have been transported by taxi or a private vehicle. Two or more compromised cardiac chambers, increased time of transportation, trauma occurred in the city outskirts, and gunshot wounds were related to increased mortality. Our data is valuable for surgeons, health system managers, and policy analysts as we conducted a holistic assessment of the anatomical and sociodemographic factors that are closely associated with mortality following a PCI. Surgeons must recognize that PCIs can occur even when the entrance wound is outside the cardiac box. Reinforcing hospital infrastructure in the outskirts and improving the availability, accuracy, and response time of first responders may lead to improved patient mortality rates.
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Affiliation(s)
- Andres Isaza-Restrepo
- Medical and Health Sciences Education Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, 111221, Colombia.
| | - Andrea Donoso-Samper
- Surgery Department, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, 111221, Colombia
| | - Elkin Benitez
- Surgery Department, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, 111221, Colombia
| | | | - Asdhar Toro
- Surgery Department, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, 111221, Colombia
| | - Daniel Felipe Ariza-Salamanca
- Medical and Health Sciences Education Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, 111221, Colombia
| | - Nora Arredondo
- Instituto Nacional de Medicina Legal y Ciencias Forenses, Bogotá, 111711, Colombia
| | - Nicolas Molano-Gonzales
- Clinical Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, 111221, Colombia
| | - Angela Maria Pinzon-Rondon
- Clinical Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, 111221, Colombia
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Fernandez-Badillo V, Garcia-Cardenas M, Oliva-Cavero D, Armendariz-Ferrari JC, Alexanderson-Rosas E, Espinola-Zavaleta N. Thoracic and Intramyocardial Pellets, an Incidental Finding in a Patient with Acute Myocardial Infarction. Arq Bras Cardiol 2022; 119:133-135. [PMID: 35830113 PMCID: PMC9352119 DOI: 10.36660/abc.20210854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 03/09/2022] [Indexed: 11/26/2022] Open
Affiliation(s)
- Valente Fernandez-Badillo
- Departamento de Cardiologia Nuclear, Instituto Nacional de Cardiologia Ignacio Chávez, Cidade do México - México
| | - Mauricio Garcia-Cardenas
- Departamento de Cardiologia Nuclear, Instituto Nacional de Cardiologia Ignacio Chávez, Cidade do México - México.,Departamento de Cardiologia, Hospital Nacional Hipólito Unanue, Lima - Peru
| | - Diego Oliva-Cavero
- Departamento de Cardiologia, Hospital Nacional Hipólito Unanue, Lima - Peru
| | | | - Erick Alexanderson-Rosas
- Departamento de Cardiologia Nuclear, Instituto Nacional de Cardiologia Ignacio Chávez, Cidade do México - México
| | - Nilda Espinola-Zavaleta
- Departamento de Cardiologia Nuclear, Instituto Nacional de Cardiologia Ignacio Chávez, Cidade do México - México
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Kumar A, Shiwalkar N, Bhate S, Keshavamurthy S. Management of Thoracic and Cardiac Trauma: A Case Series and Literature Review. Cureus 2022; 14:e26465. [PMID: 35800197 PMCID: PMC9246353 DOI: 10.7759/cureus.26465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2022] [Indexed: 11/05/2022] Open
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Sarquis LM, Brunet-Schultze AC, Gazola BB, Collaço IA, Aguiar AJDE, Fontes H. Epidemiological analysis of cardiac trauma victims at a referral trauma hospital: a 5 year case series. Rev Col Bras Cir 2022; 49:e20223120. [PMID: 35239854 PMCID: PMC10578789 DOI: 10.1590/0100-6991e-20223120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 10/06/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to describe, analyze, and trace the epidemiological profile for cardiac trauma victims on a referral trauma hospital of a major urban center. METHODS a case series study to review, describe, compile and analyze medical records of all patients sustaining traumatic cardiac injuries, from January 2015 to January 2020 admitted to the referral trauma hospital of Curitiba, Brazil. Patients sustaining traumatic heart injuries were identified using the hospitals database. Patients who died prior to reaching hospital care were excluded. RESULTS all 22 cases were urban victims, mostly penetrating injuries (12 stab wounds, 9 gunshot wounds); 82% were male; mean age, 37.1 years. 17 cases (77%) occurred during night hours, 15 between Friday and Sunday, and 15 were admitted hemodynamically stable. Only 27% were diagnosed with FAST, the remainder requiring other imaging exams. About incisions, 14 had thoracotomies, 6 median sternotomies and in 2 cases both. Of injuries, 8 affected the right ventricle, 3 right atrium, 9 left ventricle, 1 right coronary sulcus and 1 anterior wall. All had cardiorrhaphy repair. 3 patients died, 17 were discharged and 2 were transferred. 17 received postoperative echocardiograms, revealing ejection fractions ranging 55.1% to 75%. Patients spent a mean of 9.6 days on ICU and a mean of 15.2 days of total hospital stay. The mortality rate was 14%. CONCLUSIONS cardiac traumas predominantly occurred in adult males, due to violent causes, during night hours on weekends. The overall mortality rate found (14%), as well as total hospital stay, accords with the literature.
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Affiliation(s)
| | | | | | | | | | - Hector Fontes
- - Hospital do Trabalhador, General Surgery - Curitiba - PR - Brasil
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8
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Bagherieh S, Ghoshouni H, Bostan F, Afshari-Safavi A, Badihian S, Barzegar M, Shaygannejad V, Mirmosayyeb O. Incidence, Prevalence, and Characteristics of Heart Failure Among Patients with Multiple Sclerosis; A Systematic Review and Meta-Analysis. Mult Scler Relat Disord 2022; 59:103665. [DOI: 10.1016/j.msard.2022.103665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/17/2022] [Accepted: 02/03/2022] [Indexed: 11/24/2022]
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Dou LW, Du Z, Zhu JH, Wang TB. Changes and significance of serum troponin in trauma patients: A retrospective study in a level I trauma center. World J Emerg Med 2022; 13:27-31. [PMID: 35003412 PMCID: PMC8677921 DOI: 10.5847/wjem.j.1920-8642.2022.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 10/12/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Elevated troponin I (TnI) is common among trauma patients. TnI is an indicator of myocardial injury, but clinical diagnosis of blunt cardiac injury cannot be based solely on an increase in TnI. Therefore, this study aims to explore the changes and clinical significance of serum TnI in trauma patients. METHODS The clinical data of consecutive trauma patients admitted to our trauma center between July 1, 2017 and July 31, 2020 were retrospectively analyzed. According to TnI levels within 24 hours of admission, patients were divided into the elevated and normal TnI groups. According to the TnI levels after 7 days of admission, a graph depicting a change in trend was drawn and then analyzed whether TnI was related to in-hospital mortality. RESULTS A total of 166 patients (69 and 97 cases with elevated and normal TnI, respectively) were included in this study. The average hospital stay, intensive care time, mechanical ventilation time, and in-hospital mortality were higher in the elevated TnI group than in the normal TnI group (P<0.05). The TnI level of trauma patients gradually increased after admission and peaked at 48 hours (7.804±1.537 ng/mL). Subsequently, it decreased, and then recovered to normal within 7 days. However, 13 patients did not recover. Logistic regression analysis revealed that abnormal TnI at 7 days was independently related to in-hospital mortality. CONCLUSIONS Trauma patients with elevated TnI levels may have a worse prognosis. Monitoring the changes in serum TnI is important, which can reflect the prognosis better than the TnI measured immediately after admission.
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Affiliation(s)
- Li-wen Dou
- Emergency Department, Peking University People’s Hospital, Beijing 100044, China
| | - Zhe Du
- Trauma Center, Peking University People’s Hospital, Beijing 100044, China
| | - Ji-hong Zhu
- Emergency Department, Peking University People’s Hospital, Beijing 100044, China
| | - Tian-bing Wang
- Trauma Center, Peking University People’s Hospital, Beijing 100044, China
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Ahmadinejad M, Ahmadinejad I, Maghsoudi LH, Soltanian A, Safari M. Complications in Patients with Cardiac Penetrating Trauma. Cardiovasc Hematol Disord Drug Targets 2021; 21:212-216. [PMID: 34906065 DOI: 10.2174/1871529x21666211214155349] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/15/2021] [Accepted: 11/26/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cardiac penetrating trauma is a medical emergency that mostly affects young people. Based on the type of injury and associated complications, it can present as a surgical challenge and can lead to mortality. OBJECTIVE The aim of this study is to evaluate the complications of penetrating heart trauma among patients referred to Shahid Madani Hospital. METHODS In this retrospective descriptive study, the data of penetrating cardiac trauma patients referred to Shahid Madani hospital, Karaj, Tehran, from 2016-2019, were investigated. Information, including age, sex, cause of trauma, traumatized area and complications, was extracted and recorded in a data collection form. The data were evaluated statistically using SPSS v18. RESULTS A total of 44 patients were included in the study, where the mean age of the patients was 25 years. 73.3% of these patients were men and 26.7% were women. Knife stab wounds were the most prevalent cause of the trauma, present in 93.3% of patients. 73.3% of the patients had cardiac tamponade and 20% had a pneumothorax. The right ventricle was the most common site of the injury in 46.7% of the patients. A mortality rate of 3.4% was reported in this study. CONCLUSION The results of this study showed that the highest penetrating heart rate trauma occurred among young people, and the most common cause of the trauma was a knife stab. The most common area of the injury was the right ventricular, and cardiac tamponade was the most common complication.
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Affiliation(s)
- Mojtaba Ahmadinejad
- Department of Surgery, School of Medicine, Shahid Madani Hospital, Alborz University of Medical Sciences, Karaj. Iran
| | | | - Leila Haji Maghsoudi
- Department of Surgery, School of Medicine, Shahid Madani Hospital, Alborz University of Medical Sciences, Karaj. Iran
| | - Ali Soltanian
- Department of Surgery, School of Medicine, Alborz University of Medical Sciences, Karaj. Iran
| | - Mehdi Safari
- Student Research Committee, Alborz University of Medical Sciences, Karaj. Iran
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Penetrating cardiac injury caused by large glass shards stabbing to the pericardium. Asian J Surg 2021; 45:573-574. [PMID: 34815150 DOI: 10.1016/j.asjsur.2021.10.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 10/11/2021] [Indexed: 11/23/2022] Open
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12
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Fan J, Ali H. Nonpenetrating trauma resulting in hemopericardium presenting as syncope. Proc AMIA Symp 2021; 34:625-626. [PMID: 34456494 DOI: 10.1080/08998280.2021.1918818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Hemopericardium is a life-threatening condition that needs to be treated promptly to prevent serious complications. It typically results from penetrating trauma directly into the pericardial sac resulting in cardiac tamponade and death if not promptly treated. High clinical suspicion should prompt further workup even in the absence of significant injury. We present a case of a 38-year-old man who presented with blunt force trauma from a rock while mowing the lawn that resulted in syncope and hemopericardium.
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Affiliation(s)
- Jerry Fan
- Department of Internal Medicine, Baylor Scott and White Medical Center - Temple, Temple, Texas
| | - Hameed Ali
- Department of Internal Medicine, Baylor Scott and White Medical Center - Temple, Temple, Texas
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Janicic D, Simatovic M, Roljic Z, Krupljanin L, Karabeg R. Urgent Surgical Treatment of Blunt Chest Trauma Followed by Cardiac and Pericardial Injuries. Med Arch 2021; 74:115-118. [PMID: 32577052 PMCID: PMC7296422 DOI: 10.5455/medarh.2020.74.115-118] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Introduction Widespread opinion that penetrating chest injuries are more urgent, in terms of treatment and care, contributed to underestimation of the urgency of blunt chest trauma, which in most cases is treated conservatively. It remains an open question frequency when the injuries of the heart and pericardium are not timely diagnosed and surgically treated. Aim To demonstrate the importance of well-timed surgical treatment of blunt chest trauma, when coupled with cardiac and pericardial injuries. Methods At the Thoracic Surgery Clinic of the University Clinical Centre Banja Luka, Bosnia and Herzego vina, during period of 10 years (01.01. 2008 - 31.01.2018.), the total of 66 patients were treated for urgent thoracotomy due to clinically and radiologically unclear findings after blunt chest trauma. In general, diagnostic examinations, apart from laboratory analysis, included radiological imaging and Multi Slice Computed Tomography (MSCT) of the chest, followed by an ultrasound of the heart in cases when sternum was injured or when pericardial tamponade was suspected. Results presented in the study where obtained from the retrospective analysis of patients data. This work presents a retrospective observational cross-sectional study, which results in the assessment of the correctness of a particular diagnostic test. Statistical methods used descriptive statistics, counting measures (frequencies and percentages), central tendency measures (arithmetic mean), variability measures (standard deviation). Results Sixty six patients were treated with urgent thoracotomy after a blunt trauma of the chest due to the unclear clinical and radiological finding. In the case of 11 patients (10 men and 1 woman), presenting 16.6% of the total sample, pericardial and cardiac injuries were detected and treated intraoperatively. Further, in the case of the one patient, pericardiotomy and suturing of the right heart chamber where performed, with the creation of a pericardial window. Transthoracic echocardiogram was not used as the primary screening module, but rather as a diagnostic test for patients who had unexplained hypotension and arrhythmia. Radiographs of the chest showed cardiomegaly with or without epicardial fat pad sign suggesting a pericardial effusion. Conclusion Blunt cardiac and pericardial injuries represent a serious therapeutic problem, which, if not treated properly, result in a high mortality rate. Echocardiography is the primary diagnostic method for initial detection of pericardial effusion. Pericardial fluid first accumulates posterior to the heart, when the patient is examined in the supine position. As the effusion increases, it extends laterally and with large effusions the echo-free space expands to surround the entire heart. The size of the effusion may be graded as small ( echo free spaces in diastole <10 mm, corresponding to approxymately 300 ml), moderate (10-20 mm, corresponding to 500 ml), and large ( >20 mm, corresponding to >700 ml). When the ability of the pericardium to stretch is exceeded by rapid or massive accumulation of fluid, any additional fluid causes the pressure with the pericardial sac. Early recognition, pericardiotomy with pericardial window creation and/or ventricular rupture suture remain the "gold standard" in the treatment of blunt cardiac and pericardial injuries.
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Affiliation(s)
- Dusan Janicic
- Clinic for Thoracic Surgery, University Clinical Center Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Milan Simatovic
- Clinic for General and Abdominal Surgery, University Clinical Center Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Zoran Roljic
- Clinic for Vascular Surgery, University Clinical Center Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Ljiljana Krupljanin
- Clinic for Thoracic Surgery, University Clinical Center Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Reuf Karabeg
- Private Clinic "Karabeg" Sarajevo, Bosnia and Herzegovina.,Faculty of Medicine,University of Sarajevo, Sarajevo, Bosnia and Herzegovina
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14
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Tresson P, Cosset B, Vola M, Precup CG, Della-Schiava N. Left Ventricular Perforation and Improper Catheter Placement in Ascending Aorta as a Complication of Emergency Pericardiocentesis. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02790-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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15
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Abstract
Penetrating cardiac injuries have a pre-hospital mortality of 94% with a subsequent in-hospital mortality of 50% among initial survivors (Leite et al., 2017 [1]). The Western Trauma Association (WTA) guidelines recommend resuscitative thoracotomy (RT) for patients with penetrating torso trauma and less than 15 min of cardiopulmonary resuscitation (CPR) Burlew et al. (2012) [2]. Penetrating cardiac injuries are classically repaired using skin-stapling devices and/or suture repair with or without pledgets (Wall et al., 1997 [3]). In this study, we present a case of penetrating cardiac injury where all the aforementioned techniques failed, and a new approach was explored. A fibrinogen/thrombin patch was used in this clinical setting, which is an off-label use of the product, we here present our encouraging outcome.
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Van Lieshout EMM, Verhofstad MHJ, Van Silfhout DJT, Dubois EA. Diagnostic approach for myocardial contusion: a retrospective evaluation of patient data and review of the literature. Eur J Trauma Emerg Surg 2020; 47:1259-1272. [PMID: 31982920 PMCID: PMC8321993 DOI: 10.1007/s00068-020-01305-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 01/14/2020] [Indexed: 11/25/2022]
Abstract
Purpose Myocardial contusion can be a life-threatening condition in patients who sustained blunt thoracic trauma. The diagnostic approach remains a subject of debate. The aim of this study was to determine the sensitivity and specificity of echocardiography, electrocardiography, troponins T and I (TnT and TnI), and creatine kinase muscle/brain (CK-MB) for identifying patients with a myocardial contusion following blunt thoracic trauma. Methods Sensitivity and specificity were first determined in a 10-year retrospective cohort study and second by a systematic literature review with meta-analysis. Results Of the 117 patients in the retrospective study, 44 (38%) were considered positive for myocardial contusion. Chest X-ray, chest CT scan, electrocardiograph, and echocardiography had poor sensitivity (< 15%) but good specificity (≥ 90%). Sensitivity to cardiac biomarkers measured at presentation ranged from 59% for TnT to 77% for hs-TnT, specificity ranged from 63% for CK-MB to 100% for TnT. The systematic literature review yielded 28 studies, with 14.5% out of 7242 patients reported as positive for myocardial contusion. The pooled sensitivity of electrocardiography, troponin I, and CK-MB was between 62 and 71%, versus only 45% for echocardiography and 38% for troponin T. The pooled specificity ranged from 63% for CK-MB to 85% for troponin T and 88% for echocardiography. Conclusion The best diagnostic approach for myocardial contusion is a combination of electrocardiography and measurement of cardiac biomarkers. If abnormalities are found, telemonitoring is necessary for the early detection of life-threatening arrhythmias. Chest X-ray and CT scan may show other thoracic injuries but provide no information on myocardial contusion. Electronic supplementary material The online version of this article (10.1007/s00068-020-01305-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Esther M M Van Lieshout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Michael H J Verhofstad
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Dirk Jan T Van Silfhout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Eric A Dubois
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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