Blunt injury rupture of tricuspid valve and right coronary artery

Spontaneous coronary artery rupture after lung cancer surgery: A case report and review of literature

BACKGROUND

Spontaneous coronary artery rupture (SCAR) is a rare and life-threatening complication after lung cancer surgery. We present a case of SCAR following left upper lobectomy, successfully managed through emergency thoracotomy and coronary artery ligation.

CASE SUMMARY

A 61-year-old male patient underwent left upper lobectomy and mediastinal lymph node dissection for lung cancer. The surgery was performed using single-port video-assisted thoracoscopic surgery, and there were no observed complications during the procedure. However, 19 h after surgery, the patient experienced chest discomfort and subsequently developed severe symptoms, including nausea, vomiting, and a drop in blood pressure. Urgent measures were taken, leading to the diagnosis of SCAR. The patient underwent emergency thoracotomy and coronary artery ligation, successfully stopping the bleeding and stabilizing the condition. Despite postoperative complications, the patient made a successful recovery and was discharged from the hospital.

CONCLUSION

SCAR is a rare but life-threatening complication following lung cancer surgery. Immediate thoracotomy has been shown to be a life-saving measure, while stenting is not the preferred initial approach.

Unusual Cause of Severe Tricuspid Regurgitation: Tricuspid Leaflet Annular Tear Following Remote Motor Vehicle Accident

Tricuspid regurgitation (TR) is an uncommon and underdiagnosed complication of blunt chest trauma. Typical mechanisms include torn chordae, papillary muscle rupture, and radial leaflet tear. We describe an unusual case of traumatic TR due to circumferential avulsion of the anterior tricuspid leaflet from the tricuspid annulus and the crucial role of multimodality imaging in its diagnosis and treatment. (Level of Difficulty: Intermediate.).

Myocardial infarction complicating blunt chest trauma: Case report and literature review

Myocardial infarction represents a mechanical complication of blunt chest trauma, a rare but life-threatening condition in which careful evaluation is mandatory. Early intervention is crucial, and coronary stenting or bypass graft surgery is described with generally satisfactory long-term outcomes. We present a 28-year-old man who developed extensive myocardial infarction and circulatory arrest after a blunt chest trauma in a professional water polo game. The cardiac computed tomography and the coronary angiography demonstrated left main artery dissection; the echocardiogram revealed anterior myocardial infarction with a severely decreased left ventricular ejection fraction, and the patient underwent coronary angioplasty with stent implantation. Six days later, he complained about chest pain due to acute stent thrombosis, and coronary artery bypass grafting was performed. Left ventricular heart failure was treated with specific heart failure drug therapy and a biventricular pacemaker and defibrillator. Ten years later, the patient has a good quality of life, is asymptomatic and works as a water polo coach under heart failure drug therapy and regular follow-up.

Coronary artery rupture in blunt thoracic trauma: a case report and review of literature

BACKGROUND

Blunt thoracic trauma can rarely result in coronary artery injury. Blunt trauma can result in occlusion of any of the coronary arteries or can lead to its rupture and bleeding. Traumatic coronary artery occlusion can lead to myocardial infarction, while its rupture and bleeding can result in hemopericardium and cardiac tamponade, and can be rapidly fatal. Survival after coronary artery rupture in blunt thoracic trauma is exceedingly rare.

CASE PRESENTATION

We present a case of a young male who sustained a blunt thoracic trauma in a motor vehicle collision, that resulted in rupture of the left anterior descending (LAD) coronary artery and subsequent cardiac tamponade. Prompt surgical intervention with pericardiotomy and ligation of the artery has resulted in survival of the patient.

CONCLUSIONS

In cases of traumatic coronary artery rupture, early surgical intervention is crucial to avoid mortality. Ligation of the injured coronary is a viable option in selected cases, and can be the most expeditious option in patients in extremis.

Intraoperative fracture of the right coronary artery: recognition and management

We describe the recognition and management of two patients who developed intraoperative fracture of the right coronary artery (RCA). Both patients had a calcified RCA without a hemodynamically significant stenosis. Compression of the right atrioventricular groove during the surgical procedure resulted in fracture of the RCA, leading to ventricular arrhythmias and hemodynamic instability. Coronary bypass grafting without cardioplegic arrest was used for definitive diagnosis and treatment. Both patients made a rapid and uneventful recovery.

Multiple heart and pericardial lacerations due to blunt trauma from assault

A case of 80-year-old woman who died of hemorrhagic shock as a consequence of multiple heart and pericardial lacerations as well as myocardial contusion due to blunt trauma from assault is reported. At postmortem examination, fractures of the body of the sternum and bilateral ribs were detected. A laceration of the anterior left-sided pericardium, a 2.8-cm linear tear in the right venous sinus from the origin of the inferior to the origin of the superior vena cava, a 3-cm laceration between the venous sinus and the right auricle, and a 2-cm tear in the anterior wall of the left atrium, behind the aortic trunk, were visible. Multiple heart and pericardial lacerations were thought to be caused by compression of the heart between sternum and vertebrae, together with multiple rib fractures and extensive movements of the sternum toward the spine as a result of kicking.

A successfully treated case of blunt traumatic right coronary ostium rupture

Cardiac tamponade due to coronary artery rupture, as a consequence of blunt trauma, is a rare but usually fatal condition. We successfully obtained primary hemostasis with emergency room thoracotomy, followed by delayed definitive treatment of the ruptured right coronary artery ostium in a motor vehicle accident victim with multifocal hemorrhagic lesions. Survival of patients with the described serious trauma has not been reported, and we discuss herein our treatment strategy.

Trauma to cardiac valves

Cardiorrhaphy is a relatively common procedure performed in a trauma center. However, there is a subgroup of patients with more complicated cardiac injuries such as coronary artery injuries, septal defects, and valvular injuries. Cardiac valvular injuries are often diagnosed subacutely when a new murmur is heard. Transesophageal echocardiography has been increasingly performed to diagnosis these injuries and may be helpful intraoperatively. Cardiac catheterization may be indicated in selected patients. Techniques to address these injuries may involve repair or prosthetic replacement. A high index of suspicion is needed to diagnose these relatively rare injuries.

Concomitant Traumatic Coronary Artery and Tricuspid Valve Injury: A Heterogeneous Presentation

Blunt thoracic trauma resulting in both tricuspid valve rupture and coronary artery injury is uncommon, encompasses a large spectrum of presentations and, therefore, can be difficult to diagnose. This report illustrates the heterogeneous presentation and clinical course of two patients with such a combination of cardiac injuries. The patient with associated right coronary artery dissection developed progressive right ventricular failure over a 12-year period before successful surgical repair, whereas another patient with left anterior descending coronary artery thrombosis required urgent operation for acute right ventricular dysfunction and hemodynamic decompensation.