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Quintana EN, DeBose-Scarlett A, McLaren TA, Gondek SP, Smith MC, Alder MR, Baker MT, Shah AS, Absi TS. Acute cardiogenic shock secondary to blunt traumatic aortic valve injury. Trauma Case Rep 2024; 51:100995. [PMID: 38572422 PMCID: PMC10987328 DOI: 10.1016/j.tcr.2024.100995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 04/05/2024] Open
Abstract
Background Blunt cardiac injuries rarely result in aortic valve cusp rupture, leading to acute aortic insufficiency and cardiogenic shock. This rare clinical entity carries a high mortality rate if left undiagnosed and not managed surgically, with few patients surviving beyond 24 h. It presents a diagnostic challenge in the polytrauma patient in shock, with multiple possible and complementary etiologies. Case presentation We present a 56-year-old male with persistent hypotension, a wide pulse pressure, and elevated serum troponin levels suggesting blunt cardiac injury after a motor vehicle accident. Transthoracic and transesophageal echocardiography revealed normal biventricular function but severe aortic insufficiency due to prolapse of the left coronary cusp.He was taken emergently to surgery, where aortic valve exploration revealed complete left coronary cusp avulsion from the aortic annulus with a mid-cusp tear, requiring aortic valve replacement with a bioprosthetic valve. Postoperative echocardiography showed normal biventricular function with a well-seated bioprosthetic aortic valve with no insufficiency. Conclusions Traumatic aortic valve injury can lead to torn or prolapsed cusps causing acute aortic insufficiency leading to cardiogenic shock, but early recognition with appropriate and targeted diagnostic imaging is vital to prevent rapid patient deterioration and demise.
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Affiliation(s)
- Eric N. Quintana
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Alexandra DeBose-Scarlett
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Thomas A. McLaren
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Stephen P. Gondek
- Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Michael C. Smith
- Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Madeleine R. Alder
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Michael T. Baker
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Ashish S. Shah
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Tarek S. Absi
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, United States of America
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2
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Harutyunyan H, Chukwuka N, Farooqui AA, Tamazyan V, Batikyan A, Khachatryan A, Borgen E, Kerstein J. From Chest Trauma to Coronary Artery Dissection. Cureus 2024; 16:e61003. [PMID: 38910765 PMCID: PMC11194019 DOI: 10.7759/cureus.61003] [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: 05/24/2024] [Indexed: 06/25/2024] Open
Abstract
Despite being rare, traumatic coronary artery dissection after blunt chest trauma can lead to life-threatening consequences that can be fatal. This case report focuses on a 51-year-old woman who suffered chest trauma at home and was later found to have right coronary artery dissection. This manuscript aims to elucidate the risk factors, diagnostic challenges, and management strategies associated with traumatic coronary artery dissection. This case report emphasizes the evaluation of risk factors, the significance of early detection with appropriate imaging modalities while maintaining high clinical suspicion, and the critical necessity of optimizing patient outcomes in such circumstances.
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Affiliation(s)
- Hakob Harutyunyan
- Department of Internal Medicine, Maimonides Medical Center, New York, USA
| | - Nnamdi Chukwuka
- Department of Cardiology, Maimonides Medical Center, New York, USA
| | - Arafat Ali Farooqui
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, USA
| | - Vahagn Tamazyan
- Department of Internal Medicine, Maimonides Medical Center, New York, USA
| | - Ashot Batikyan
- Department of Internal Medicine, North Central Bronx Hospital, New York, USA
| | - Aleksan Khachatryan
- Department of Internal Medicine, University of Maryland Medical Center, Midtown Campus, Baltimore, USA
| | - Elliot Borgen
- Department of Cardiology, Maimonides Medical Center, New York, USA
| | - Joshua Kerstein
- Department of Cardiology, Maimonides Medical Center, New York, USA
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3
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Keane RR, Menon V, Cremer PC. Acute Heart Valve Emergencies. Cardiol Clin 2024; 42:237-252. [PMID: 38631792 DOI: 10.1016/j.ccl.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Within the cardiac intensive care unit, prompt recognition of severe acute valvular lesions is essential because hemodynamic collapse can occur rapidly, especially when cardiac chambers have not had time for compensatory remodeling. Within this context, optimal medical management, considerations for temporary mechanical circulatory support and decisive treatments strategies are addressed. Fundamental concepts include an appreciation for how sudden changes in flow and pressure gradients between cardiac chambers can impact hemodynamic and echocardiographic findings differently compared to similarly severe chronic lesions, as well as understanding the main causes for decompensated heart failure and cardiogenic shock for each valvular abnormality.
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Affiliation(s)
- Ryan R Keane
- Department of Cardiovascular Medicine, Cleveland Clinic Coordinating Center for Clinical Research, Heart Vascular and Thoracic Institute, 9500 Euclid Ave: Desk J1-5, Cleveland, OH 44195, USA
| | - Venu Menon
- Department of Cardiovascular Medicine, Cleveland Clinic Coordinating Center for Clinical Research, Heart Vascular and Thoracic Institute, 9500 Euclid Ave: Desk J1-5, Cleveland, OH 44195, USA
| | - Paul C Cremer
- Department of Cardiovascular Medicine, Cleveland Clinic Coordinating Center for Clinical Research, Heart Vascular and Thoracic Institute, 9500 Euclid Ave: Desk J1-5, Cleveland, OH 44195, USA.
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Noda K, Takahashi Y, Morisaki A, Sakon Y, Nishiya K, Inno G, Nishimoto Y, Sumii Y, Nagao M, Shibata T. Delayed traumatic aortic valve perforation after blunt chest trauma. Surg Case Rep 2024; 10:39. [PMID: 38353758 PMCID: PMC10866806 DOI: 10.1186/s40792-024-01837-6] [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: 12/11/2023] [Accepted: 02/04/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Aortic valve perforation is a rare complication of blunt chest trauma. We report a case of delayed aortic insufficiency presenting several months after trauma. CASE PRESENTATION A 17-year-old male presented to the emergency department with traumatic brain injuries and blunt chest trauma, but no evidence of cardiac injuries. Three months later, he developed acute heart failure due to severe aortic valve regurgitation with left ventricular dysfunction. A sizable tear in the right coronary cusp caused aortic insufficiency. He was treated successfully by surgical replacement with an aortic bioprosthesis. CONCLUSION We reported a successful surgical case of valve replacement for delayed aortic valve perforation. Delayed valve perforation should be kept in mind after blunt chest trauma.
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Affiliation(s)
- Kazuki Noda
- Department of Cardiovascular Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahichou, Abenoku, Osaka, 545-8585, Japan.
| | - Yosuke Takahashi
- Department of Cardiovascular Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahichou, Abenoku, Osaka, 545-8585, Japan
| | - Akimasa Morisaki
- Department of Cardiovascular Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahichou, Abenoku, Osaka, 545-8585, Japan
| | - Yoshito Sakon
- Department of Cardiovascular Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahichou, Abenoku, Osaka, 545-8585, Japan
| | - Kenta Nishiya
- Department of Cardiovascular Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahichou, Abenoku, Osaka, 545-8585, Japan
| | - Goki Inno
- Department of Cardiovascular Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahichou, Abenoku, Osaka, 545-8585, Japan
| | - Yukihiro Nishimoto
- Department of Cardiovascular Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahichou, Abenoku, Osaka, 545-8585, Japan
| | - Yosuke Sumii
- Department of Cardiovascular Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahichou, Abenoku, Osaka, 545-8585, Japan
| | - Munehide Nagao
- Department of Cardiovascular Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahichou, Abenoku, Osaka, 545-8585, Japan
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahichou, Abenoku, Osaka, 545-8585, Japan
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5
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Delia VI, Emmanouil D, Theodora KA, Dimitra K, Athanasios K. Missed Coronary Artery Dissection Post-Blunt Chest Trauma. Cureus 2023; 15:e47630. [PMID: 38022221 PMCID: PMC10680047 DOI: 10.7759/cureus.47630] [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: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Cardiac contusion is rarely diagnosed in patients with blunt chest trauma in the emergency department, especially if patients are asymptomatic. We present a case of a 43-year-old man whose diagnosis of left anterior descending artery (LAD) dissection after blunt chest trauma was delayed. The patient presented to the emergency department of a remote district hospital after a motorcycle accident, asymptomatic with a mildly reduced level of consciousness due to a very small subdural hemorrhage. Ten days later, when he developed a syncopal attack due to a massive pulmonary embolism (PE), his first performed electrocardiogram (ECG) showed sinus rhythm with QS waves and slight ST elevation in leads V2-V6. The subsequent coronary angiography showed left anterior descending artery dissection, and the diagnosis was nicely depicted with optical coherence tomography (OCT). A drug-eluting stent was implanted with a good angiographic result. This case highlights the significance of early recognition of traumatic coronary dissection, which should be excluded even in asymptomatic patients with a plain ECG acquisition, for the appropriate management and prevention of unfavorable outcomes.
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Affiliation(s)
- Vlad I Delia
- 2nd Department of Cardiology, General Hospital of Nikea, Piraeus, GRC
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6
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Kondo M, Ijuin S, Haraguchi T, Izumi S, Kanno R, Sakaguchi K, Edono K, Nakayama H, Ishihara S, Tsukube T. The role and timing of cardiopulmonary bypass in the surgical repair of traumatic cardiac injury. Gen Thorac Cardiovasc Surg 2023; 71:561-569. [PMID: 37009955 DOI: 10.1007/s11748-023-01931-w] [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: 01/24/2023] [Accepted: 03/22/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVES The management of traumatic cardiac injury (TCI) may require a prompt treatment, including the use of cardiopulmonary bypass (CPB) followed by surgical repair. This study evaluated the surgical outcomes among TCI patients. METHODS From August 2003, 21 patients with TCI were underwent emergent surgical repair. TCI was classified as grade I to VI according to the Cardiac Injury Organ Scale (CIS) of the American Association for Surgery of Trauma, and severity was evaluated using the Injury Severity Score (ISS). RESULTS Of the 21 patients, the mean age and ISS were 54.8 ± 18.8 years and 26.5 ± 6.3, respectively, including13 blunt and eight penetrating injuries. A CIS grade of IV or greater was observed in 17 patients and unstable hemodynamics in 16. CPB or extracorporeal membranous oxygenation (ECMO) were used in three patients before they underwent surgery and in seven patients after undergoing sternotomy, including three on whom a canular access route was prepared preoperatively. There was a significant correlation between the preoperative width of pericardial effusion and the use of CPB (p < 0.05). Overall hospital mortality was 14.3%, and 100% in patients with uncontrolled bleeding during surgery. All patients who underwent CPB before or during surgery, in whom a standby canular access route had been established, survived. CONCLUSIONS TCI is associated with a high mortality rate, and survival depends on efficient diagnosis and the rapid mobilization of the operating room. Preparations for CPB or establishing a canular access route should be made before surgical procedures in cases in which the hemodynamics are unstable.
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Affiliation(s)
- Mayo Kondo
- Division of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital & Hyogo Emergency Medical Center, 1-3-1 Wakihama-Kaigandori Chuo-Ku, Kobe, 651-0073, Japan
| | - Shinichi Ijuin
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
| | - Tomonori Haraguchi
- Division of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital & Hyogo Emergency Medical Center, 1-3-1 Wakihama-Kaigandori Chuo-Ku, Kobe, 651-0073, Japan
| | - So Izumi
- Division of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital & Hyogo Emergency Medical Center, 1-3-1 Wakihama-Kaigandori Chuo-Ku, Kobe, 651-0073, Japan
| | - Reiko Kanno
- Division of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital & Hyogo Emergency Medical Center, 1-3-1 Wakihama-Kaigandori Chuo-Ku, Kobe, 651-0073, Japan
| | - Kazunori Sakaguchi
- Division of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital & Hyogo Emergency Medical Center, 1-3-1 Wakihama-Kaigandori Chuo-Ku, Kobe, 651-0073, Japan
| | - Kazumasa Edono
- Department of Clinical Engineering, Japanese Red Cross Kobe Hospital & Hyogo Emergency Medical Center, Kobe, Japan
| | - Haruki Nakayama
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
| | - Satoshi Ishihara
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
| | - Takuro Tsukube
- Division of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital & Hyogo Emergency Medical Center, 1-3-1 Wakihama-Kaigandori Chuo-Ku, Kobe, 651-0073, Japan.
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7
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Wu J, Lee J, Jung JY, Hwang JH, Kim KS, Shin M, Lee H, Park SH. Less-Suture Vascular Anastomosis: Development of Alternative Protocols with Multifunctional Self-Wrapping, Transparent, Adhesive, and Elastic Biomaterials. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2023; 35:e2301098. [PMID: 37196994 DOI: 10.1002/adma.202301098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 05/04/2023] [Indexed: 05/19/2023]
Abstract
Blood vessel anastomosis by suture is a life-saving, yet time-consuming and labor-intensive operation. While suture-less alternatives utilizing clips or related devices are developed to address these shortcomings, suture anastomosis is still overwhelmingly used in most cases. In this study, practical "less-suture" strategies are proposed, rather than ideal "suture-less" methods, to reflect real-world clinical situations. In the case of rat artery (d = 0.64 mm) anastomosis, the less-suture anastomosis involves the application of thin, adhesive, transparent, and self-wrapping films to the site. This surprisingly reduces the number of stitches required from ten (without films) to four (with films), saving 27 min of operating time per vessel. Furthermore, the decreased number of stitches largely alleviates fibrosis-mediated wall-thickening. Thus, a less-suture strategy is particularly useful for anastomosis of multiple vessels in emergency conditions and small-diameter vessels.
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Affiliation(s)
- Jingxian Wu
- Department of Chemistry, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, 34141, Republic of Korea
| | - Jaemeun Lee
- R&D Center for Advanced Pharmaceuticals & Evaluation, Korea Institute of Toxicology (KIT), Daejeon, 34114, Republic of Korea
| | - Joo Young Jung
- Orthopaedic Department, Seail Hospital, Busan, 48793, Republic of Korea
| | - Jeong Ho Hwang
- Animal Model Research Group, Korea Institute of Toxicology (KIT), Jeongeup, 56212, Republic of Korea
- Human and Environmental Toxicology, Korea University of Science and Technology (UST), Daejeon, 34113, Republic of Korea
| | - Ki-Suk Kim
- R&D Center for Advanced Pharmaceuticals & Evaluation, Korea Institute of Toxicology (KIT), Daejeon, 34114, Republic of Korea
| | - Mikyung Shin
- Department of Biomedical Engineering, Sungkyunkwan University (SKKU), Suwon, 16419, Republic of Korea
- Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University (SKKU), Suwon, 16419, Republic of Korea
| | - Haeshin Lee
- Department of Chemistry, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, 34141, Republic of Korea
| | - Sun-Hyun Park
- R&D Center for Advanced Pharmaceuticals & Evaluation, Korea Institute of Toxicology (KIT), Daejeon, 34114, Republic of Korea
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8
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de Castro D, Rasines-Rodríguez A, Usano A, Mingo S. Acute Post-Traumatic Aortic Regurgitation. JACC Case Rep 2022; 4:1432-1434. [PMID: 36388713 PMCID: PMC9663896 DOI: 10.1016/j.jaccas.2022.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/28/2022] [Accepted: 07/07/2022] [Indexed: 06/16/2023]
Abstract
A 16-year-old girl with a history of blunt chest trauma was admitted because of heart failure symptoms. Transthoracic echocardiography showed severe eccentric aortic regurgitation. Cardiac computed tomography revealed a pseudoaneurysm of the right sinus of Valsalva. We present a rare clinical presentation of a life-threatening condition. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Daniel de Castro
- Department of Cardiology, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
| | | | - Ana Usano
- Department of Pediatric Cardiology, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
| | - Susana Mingo
- Department of Cardiology, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
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9
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Factors Associated with Cardiac/Pericardial Injury among Blunt Injury Patients: A Nationwide Study in Japan. J Clin Med 2022; 11:jcm11154534. [PMID: 35956149 PMCID: PMC9369737 DOI: 10.3390/jcm11154534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/26/2022] [Accepted: 08/01/2022] [Indexed: 11/20/2022] Open
Abstract
The lack of established diagnostic criteria makes diagnosing blunt cardiac injury difficult. We investigated the factors associated with blunt cardiac injury using the Japan Trauma Data Bank (JTDB) in a multicenter observational study of blunt trauma patients conducted between 2004 and 2018. The primary outcome was the incidence of blunt cardiac/pericardial injury. Multivariable logistic regression analysis was used to identify factors independently associated with blunt cardiac injuries. Of the 228,513 patients, 1002 (0.4%) had blunt cardiac injury. Hypotension on hospital arrival (adjusted odds ratio (AOR) 4.536, 95% confidence interval (CI) 3.802–5.412), thoracic aortic injury (AOR 2.722, 95% CI 1.947–3.806), pulmonary contusion (AOR 2.532, 95% CI 2.204–2.909), rib fracture (AOR 1.362, 95% CI 1.147–1.618), sternal fracture (AOR 3.319, 95% CI 2.696–4.085). and hemothorax/pneumothorax (AOR 1.689, 95% CI 1.423–2.006)) was positively associated with blunt cardiac injury. Regarding the types of patients, car drivers had a higher rate of blunt cardiac injury compared to other types of patients. Driving a car, hypotension on hospital arrival, thoracic aortic injury, pulmonary contusion, rib fracture, sternal fracture, and hemothorax/pneumothorax were positively associated with blunt cardiac injury.
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10
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Kim M, Choi SW, Han J, Yu JH, Park JH. Successful surgical closure of an isolated traumatic atrial septal defect after a device closure failure. JTCVS Tech 2022; 14:104-106. [PMID: 35967237 PMCID: PMC9367196 DOI: 10.1016/j.xjtc.2022.06.006] [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: 02/08/2022] [Revised: 03/24/2022] [Accepted: 04/11/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Mijoo Kim
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Si Wan Choi
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jonghee Han
- Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jae Hyeon Yu
- Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jae-Hyeong Park
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
- Address for reprints: Jae-Hyeong Park, MD, PhD, Department of Cardiology in Internal Medicine, Chungnam National University, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Korea.
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11
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Kumar SP, Asokan Y, Balamurugan K, Harsha B. A review of wound dressing materials and its fabrication methods: emphasis on three-dimensional printed dressings. J Med Eng Technol 2022; 46:318-334. [PMID: 35212596 DOI: 10.1080/03091902.2022.2041750] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
A wound is a trauma caused by some adverse external or blunt forces that can damage the body tissues. Wound healing is a complex process that occurs post-injury which involves the revamping of the structure and function of damaged tissues. Scaffolds are engineered tissue structures manufactured using different materials and methods for facilitating the wound healing process. For external wounds, the antimicrobial property and ability to absorb moisture play an important role in the material selection of the scaffold. Among different methods that exist for designing scaffolds, three-dimensional printing has emerged as a promising technique wherein customised scaffolds can be designed. However, the literature on three-dimensional printed dressings is very much limited compared to conventional ones. Therefore, this review specifically focuses on the methods used to design the scaffolds with special emphasis on different three-dimensional printing techniques. It covers the process of external wound healing, different materials used in the fabrication of scaffolds, and their advantages and drawbacks.
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Affiliation(s)
- S Pravin Kumar
- Center for Healthcare Technologies, Department of Biomedical Engineering, Sri Sivasubramaniya Nadar college of Engineering, Chennai, India
| | - Yuvasri Asokan
- Center for Healthcare Technologies, Department of Biomedical Engineering, Sri Sivasubramaniya Nadar college of Engineering, Chennai, India
| | - Keerthana Balamurugan
- Center for Healthcare Technologies, Department of Biomedical Engineering, Sri Sivasubramaniya Nadar college of Engineering, Chennai, India
| | - B Harsha
- Center for Healthcare Technologies, Department of Biomedical Engineering, Sri Sivasubramaniya Nadar college of Engineering, Chennai, India
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12
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Nasser K, Matsuura J, Diep J. Blunt Chest Trauma Causing a Displaced Sternal Fracture and ST-elevation Myocardial Infarction: A Case Report. Clin Pract Cases Emerg Med 2021; 5:85-88. [PMID: 33560960 PMCID: PMC7872601 DOI: 10.5811/cpcem.2020.12.49875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/11/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Blunt chest trauma and motor vehicle collisions are common presentations to the emergency department (ED). Chest pain in a trauma patient can usually and reasonably be attributed to chest wall injury, leading to a potential delay in diagnosis and treatment. CASE REPORT In this case report, we present a 52-year-old male who was brought to the ED with complaints of chest pain and pressure after a motor vehicle collision. He was subsequently found to have both a displaced sternal fracture and simultaneous acute myocardial infarction with 100% occlusion of the mid left anterior descending artery without dissection requiring stent placement. CONCLUSION Chest pain after blunt cardiac trauma is a common complaint. While rare, acute myocardial infarction must be considered. Most injuries result as direct trauma to the artery causing either dissection or acute thrombosis resulting in a myocardial infarction as opposed to acute plaque rupture with thrombosis, as seen in this case.
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Affiliation(s)
- Keaton Nasser
- University of Nevada Las Vegas, Department of Cardiology, Las Vegas, Nevada
| | - Jaclyn Matsuura
- University of Nevada Las Vegas, Department of Emergency Medicine, Las Vegas, Nevada
| | - Jimmy Diep
- University of Nevada Las Vegas, Department of Cardiology, Las Vegas, Nevada.,Nevada Heart and Vascular Center, Department of Cardiology, Las Vegas, Nevada
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13
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Shah S, Huda S, Raj V. Blunt Chest Wall Trauma and Troponin Elevation: Is It a Cardiac Contusion or a Myocardial Infarction? Am J Med 2021; 134:e113-e114. [PMID: 32835691 DOI: 10.1016/j.amjmed.2020.06.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Siddharth Shah
- Department of Cardiology, State University of New York Upstate Medical University, Syracuse.
| | - Syed Huda
- Department of Internal Medicine, State University of New York Upstate Medical University, Syracuse
| | - Vijay Raj
- Department of Cardiology, State University of New York Upstate Medical University, Syracuse
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14
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Pandey Y, Owen B, Birnbaum G, Tabbaa R, Hamzeh I, Lakkis N, Kayani W. Multivessel Traumatic Coronary Artery Dissection After a Motor Vehicle Accident With Successful Percutaneous Coronary Intervention. JACC Case Rep 2020; 2:2295-2298. [PMID: 34317158 PMCID: PMC8304532 DOI: 10.1016/j.jaccas.2020.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/08/2020] [Accepted: 09/18/2020] [Indexed: 11/20/2022]
Abstract
Coronary artery dissection is a rare complication of blunt chest wall trauma. We report a case of acute left anterior descending and right coronary artery dissections after a motor vehicle accident. The musculoskeletal injuries obscured the cardiac symptoms. Electrocardiogram and bedside echocardiogram revealed cardiac pathology, which prompted urgent coronary angiography and intervention. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Yagya Pandey
- Baylor College of Medicine, Ben Taub General Hospital, Houston, Texas, USA
| | - Brittany Owen
- Baylor College of Medicine, Ben Taub General Hospital, Houston, Texas, USA
| | - Gilad Birnbaum
- Baylor College of Medicine, Ben Taub General Hospital, Houston, Texas, USA
| | - Rashed Tabbaa
- Baylor College of Medicine, Ben Taub General Hospital, Houston, Texas, USA
| | - Ihab Hamzeh
- Baylor College of Medicine, Ben Taub General Hospital, Houston, Texas, USA
| | - Nasser Lakkis
- Baylor College of Medicine, Ben Taub General Hospital, Houston, Texas, USA
| | - Waleed Kayani
- Baylor College of Medicine, Ben Taub General Hospital, Houston, Texas, USA
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15
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Pendleton AC, Leichtle SW. Cardiac Tamponade From Blunt Trauma. Am Surg 2020; 88:1319-1321. [PMID: 32856932 DOI: 10.1177/0003134820942170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Audrey C Pendleton
- 72054 Division of Acute Care Surgical Services, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Stefan W Leichtle
- 72054 Division of Acute Care Surgical Services, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
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16
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Gelves J, Vasquez-Rodriguez JF, Medina HM, Marquez D, Jaimes C, Salazar G, Manrique F. Severe Aortic and Tricuspid Valve Regurgitation after Blunt Chest Trauma: An Unusual Presentation. ACTA ACUST UNITED AC 2020; 4:230-235. [PMID: 32875187 PMCID: PMC7451891 DOI: 10.1016/j.case.2020.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Heart valve injuries resulting in acute valvular insufficiency are rare complications of BCT. Aortic valve is the most frequently injured valve after BCT. Severe regurgitation in two different valves within the same patient is extremely rare. Post-traumatic aortic and mitral regurgitation can lead to rapidly progressing heart failure. Patients with acute heart failure after BCT should immediately undergo surgical repair.
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Affiliation(s)
- Julian Gelves
- Division of Cardiology, Department of Clinical Cardiology, Fundación Cardioinfantil - Instituto de Cardiología, Bogota D.C., Colombia
- Department of Cardiovascular Imaging, Division of Cardiology, Fundación Cardioinfantil - Instituto de Cardiología, Bogota D.C., Colombia
| | - Juan Felipe Vasquez-Rodriguez
- Division of Cardiology, Department of Clinical Cardiology, Fundación Cardioinfantil - Instituto de Cardiología, Bogota D.C., Colombia
- Facultad de Medicina y Ciencias de la Salud, Medical Graduate Department, Universidad El Bosque, Bogota D.C., Colombia
| | - Hector M Medina
- Division of Cardiology, Department of Clinical Cardiology, Fundación Cardioinfantil - Instituto de Cardiología, Bogota D.C., Colombia
- Department of Cardiovascular Imaging, Division of Cardiology, Fundación Cardioinfantil - Instituto de Cardiología, Bogota D.C., Colombia
| | - Diego Marquez
- Division of Cardiology, Department of Clinical Cardiology, Fundación Cardioinfantil - Instituto de Cardiología, Bogota D.C., Colombia
- Medical Graduate Department, Universidad del Rosario Escuela de Medicina y Ciencias de la Salud, Bogota D.C., Colombia
- Department of Cardiovascular Surgery, Division of Cardiology, Fundación Cardioinfantil - Instituto de Cardiología, Bogota D.C., Colombia
| | - Claudia Jaimes
- Division of Cardiology, Department of Clinical Cardiology, Fundación Cardioinfantil - Instituto de Cardiología, Bogota D.C., Colombia
- Department of Cardiovascular Imaging, Division of Cardiology, Fundación Cardioinfantil - Instituto de Cardiología, Bogota D.C., Colombia
| | - Gabriel Salazar
- Division of Cardiology, Department of Clinical Cardiology, Fundación Cardioinfantil - Instituto de Cardiología, Bogota D.C., Colombia
- Department of Cardiovascular Imaging, Division of Cardiology, Fundación Cardioinfantil - Instituto de Cardiología, Bogota D.C., Colombia
| | - Frida Manrique
- Division of Cardiology, Department of Clinical Cardiology, Fundación Cardioinfantil - Instituto de Cardiología, Bogota D.C., Colombia
- Department of Cardiovascular Imaging, Division of Cardiology, Fundación Cardioinfantil - Instituto de Cardiología, Bogota D.C., Colombia
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17
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Forteleoni A, Montereggi F, Sanna GD, Portoghese M, Parodi G. Traumatic mitral valve regurgitation. J Cardiovasc Med (Hagerstown) 2019; 20:709-717. [DOI: 10.2459/jcm.0000000000000809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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18
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Blunt traumatic scapular fractures are associated with great vessel injuries in children. J Trauma Acute Care Surg 2019; 85:932-935. [PMID: 29787531 DOI: 10.1097/ta.0000000000001980] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Patients with stable blunt great vessel injury (GVI) can have poor outcomes if the injury is not identified early. With current pediatric trauma radiation reduction efforts, these injuries may be missed. As a known association between scapular fracture and GVI exists in adult blunt trauma patients, we examined whether that same association existed in pediatric blunt trauma patients. METHODS Bluntly injured patients younger than 18 years old were identified from 2012 to 2014 in the National Trauma Data Bank. Great vessel injury included all major thoracic vessels and carotid/jugular. Demographics of patients with and without scapular fracture were compared with descriptive statistics. The χ test was used to examine this association using SAS Version 9.4 (SAS Institute, Inc, Cary, NC). RESULTS We found a significant association between pediatric scapular fracture and GVI. Of 291,632 children identified, 1,960 had scapular fractures. Children with scapular fracture were 10 times more likely to have GVI (1.2%) compared to those without (0.12%, p < 0.0001). Most common GVI seen were carotid artery, thoracic aorta, and brachiocephalic or subclavian artery or vein. Children with both scapular fracture and GVI were most commonly injured by motor vehicles (57% collision, 26% struck). CONCLUSIONS Injured children with blunt scapular fracture have a 10-fold greater risk of having a GVI when compared to children without scapular fracture. Presence of blunt traumatic scapular fracture should have appropriate index of suspicion for a significant GVI in pediatric trauma patients. LEVEL OF EVIDENCE Epidemiologic and prognostic study, level III; Therapeutic, level IV.
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19
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Hussain A, Youssefi P, Soppa G, Jahangiri M. Novel Approach to Repairing a Traumatic Aortic Arch Pseudoaneurysm Following a Fall. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2019; 7:15-17. [PMID: 31330547 PMCID: PMC6645912 DOI: 10.1055/s-0039-1687902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Traumatic pseudoaneurysms of the aortic arch are often treated with surgical repair regardless of the lesion size or age. The authors report a simple, less invasive surgical repair in a patient who sustained blunt aortic injury following a fall.
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Affiliation(s)
- Azhar Hussain
- Department of Cardiothoracic Surgery, St. George's Hospital, London, United Kingdom
| | - Pouya Youssefi
- Department of Cardiothoracic Surgery, St. George's Hospital, London, United Kingdom
| | - Gopal Soppa
- Department of Cardiothoracic Surgery, St. George's Hospital, London, United Kingdom
| | - Marjan Jahangiri
- Department of Cardiothoracic Surgery, St. George's Hospital, London, United Kingdom
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20
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Son SA, Jung H, Cho JY, Oh TH, Do YW, Lim KH, Kim GJ. Mid-term outcomes of endovascular repair for traumatic thoracic aortic injury: a single-center experience. Eur J Trauma Emerg Surg 2019; 45:965-972. [PMID: 31183525 DOI: 10.1007/s00068-019-01166-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 06/04/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Thoracic endovascular aortic repair (TEVAR) for traumatic thoracic aortic injury (TTAI) reports short-term benefits. However, long-term durability and the need of reintervention remain unclear. Here, we determined mid-term outcome of TEVAR for TTAI and investigated the influence of the length of proximal landing zone on aorta. METHODS Between October 2009 and February 2018, 69 patients diagnosed TTAI and 42 included patients underwent TEVAR. Patients were divided into two groups by the length of proximal landing zone; ≤ 20 mm and > 20 mm. The primary endpoint was success and survival rate, and the secondary endpoint was the increase of aorta size and the need of reintervention. RESULTS The mean follow-up period was 47.9 ± 29.6 months and 100% success rate. No endoleaks or additional reinterventions during the follow-up period. The cumulative survival of all-cause death was 90.5 ± 2.3%, 85.7 ± 4.1% and 61.7 ± 8.4% at 1, 5 and 7 years, respectively. There was no statistically significant difference in the increase of aorta size due to the length of the proximal landing zone (p = 0.65). CONCLUSION In selective TTAI patients for TEVAR, the length of proximal landing zone did not considerably influence the aorta size or needed further reintervention.
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Affiliation(s)
- Shin-Ah Son
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, Republic of Korea
| | - Hanna Jung
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, Republic of Korea
| | - Joon Yong Cho
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, Republic of Korea
| | - Tak-Hyuk Oh
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, Republic of Korea
| | - Young Woo Do
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, Republic of Korea
| | - Kyoung Hoon Lim
- Trauma Center, Department of Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Gun-Jik Kim
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, Republic of Korea.
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21
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Traumatic Ventricular Septal Defect in a 1-Year-Old Boy After Accidental Chest Compression by an Adult. Pediatr Emerg Care 2019; 35:e90-e92. [PMID: 28225378 DOI: 10.1097/pec.0000000000001077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We report a 1-year-old boy with a delayed diagnosis of traumatic ventricular septal defect (VSD) related to chest compression. His cardiac function was stable after adequate medical treatment. Spontaneous closure of traumatic VSD occurred to this patient at the age of 4 years. This is a rare case of traumatic VSD associated with accidental chest compression, which is similar to rupture of the ventricular septum after blunt chest trauma. It should be kept in mind that traumatic VSD and concomitant thoracic injuries can develop during chest compression. The clinician should pay attention to the potential risk of traumatic VSD in patients experiencing chest compression. Echocardiography is a convenient and effective tool for serial follow-up examination and avoiding the delayed diagnosis. Troponin I level can be a useful screening test. Conservative management of traumatic VSD with hemodynamic stability is recommended because of possible spontaneous closure.
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22
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Fatal delayed hemopericardium and hemothorax following blunt chest trauma. Forensic Sci Med Pathol 2019; 15:272-275. [DOI: 10.1007/s12024-018-0069-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2018] [Indexed: 11/26/2022]
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23
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Mylonas KS, Tsilimigras DI, Texakalidis P, Hemmati P, Schizas D, Economopoulos KP. Pediatric Cardiac Trauma in the United States: A Systematic Review. World J Pediatr Congenit Heart Surg 2018; 9:214-223. [PMID: 29544413 DOI: 10.1177/2150135117747488] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Literature discussing cardiac injuries in children is limited. Systematic search of PubMed identified 21 studies enrolling 1,062 pediatric patients who experienced cardiac trauma in the United States during the period 1961 to 2012. The predominant type of injury was blunt cardiac contusion affecting 59.7% (n = 634/1,062) of the study population. Motor vehicle crashes (53.5%, n = 391/731) were the leading cause of blunt cardiac trauma, while gunshot wounds (50%, n = 150/300) accounted for most penetrating injuries. Overall mortality rate was 35.2% (n = 374/1,062).
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Affiliation(s)
- Konstantinos S Mylonas
- 1 Division of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,2 Surgery Working Group, Society of Junior Doctors, Athens, Greece
| | - Diamantis I Tsilimigras
- 2 Surgery Working Group, Society of Junior Doctors, Athens, Greece.,3 School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Pavlos Texakalidis
- 2 Surgery Working Group, Society of Junior Doctors, Athens, Greece.,4 School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pouya Hemmati
- 5 Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Dimitrios Schizas
- 2 Surgery Working Group, Society of Junior Doctors, Athens, Greece.,6 First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos P Economopoulos
- 2 Surgery Working Group, Society of Junior Doctors, Athens, Greece.,7 Department of Surgery, Duke University Medical Center, Durham, NC, USA
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24
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Grigorian A, Milliken J, Livingston JK, Spencer D, Gabriel V, Schubl SD, Kong A, Barrios C, Joe V, Nahmias J. National risk factors for blunt cardiac injury: Hemopneumothorax is the strongest predictor. Am J Surg 2018; 217:639-642. [PMID: 30060913 DOI: 10.1016/j.amjsurg.2018.07.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 07/20/2018] [Accepted: 07/24/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Blunt cardiac injury (BCI) can occur after chest trauma and may be associated with sternal fracture (SF). We hypothesized that injuries demonstrating a higher transmission of force to the thorax, such as thoracic aortic injury (TAI), would have a higher association with BCI. METHODS We queried the National Trauma Data Bank (NTDB) from 2007-2015 to identify adult blunt trauma patients. RESULTS BCI occurred in 15,976 patients (0.3%). SF had a higher association with BCI (OR = 5.52, CI = 5.32-5.73, p < 0.001) compared to TAI (OR = 4.82, CI = 4.50-5.17, p < 0.001). However, the strongest independent predictor was hemopneumothorax (OR = 9.53, CI = 7.80-11.65, p < 0.001) followed by SF and esophageal injury (OR = 5.47, CI = 4.05-7.40, p < 0.001). CONCLUSION SF after blunt trauma is more strongly associated with BCI compared to TAI. However, hemopneumothorax is the strongest predictor of BCI. We propose all patients presenting after blunt chest trauma with high-risk features including hemopneumothorax, sternal fracture, esophagus injury, and TAI be screened for BCI. SUMMARY Using the National Trauma Data Bank, sternal fracture is more strongly associated with blunt cardiac injury than blunt thoracic aortic injury. However, hemopneumothorax was the strongest predictor.
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Affiliation(s)
- Areg Grigorian
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA.
| | - Jeffrey Milliken
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Joshua K Livingston
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Dean Spencer
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Viktor Gabriel
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Sebastian D Schubl
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Allen Kong
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Cristobal Barrios
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Victor Joe
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Jeffry Nahmias
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
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25
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Thomas B, Durant E, Barbant S, Nagdev A. Repeat Point-of-Care Echocardiographic Evaluation of Traumatic Cardiac Arrest: A New Paradigm for the Emergency Physician. Clin Pract Cases Emerg Med 2018; 1:194-196. [PMID: 29849292 PMCID: PMC5965168 DOI: 10.5811/cpcem.2017.2.33021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 02/09/2017] [Accepted: 02/22/2017] [Indexed: 12/27/2022] Open
Abstract
We report a case of a 52-year-old man who presented to the emergency department (ED) in extremis (hypotensive with an altered sensorium) with subsequent cardiac arrest after a motor vehicle collision. The initial trauma evaluation did not reveal a source of the hemodynamic compromise. A point-of-care ultrasound revealed severe mitral regurgitation secondary to an anterolateral papillary muscle rupture. Patient underwent successful emergent mitral valve replacement after initial resuscitative efforts and intraaortic balloon pump placement.
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Affiliation(s)
- Benjamin Thomas
- Highland General Hospital, Department of Emergency Medicine, Oakland, California
| | - Edward Durant
- Highland General Hospital, Department of Emergency Medicine, Oakland, California
| | - Sophie Barbant
- Highland General Hospital, Department of Cardiology, Oakland, California
| | - Arun Nagdev
- Highland General Hospital, Department of Emergency Medicine, Oakland, California
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26
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Kokubun T, Oikawa M, Ichijo Y, Matsumoto Y, Yokokawa T, Nakazato K, Sato Y, Takase S, Shinjo H, Yokoyama H, Suzuki H, Saitoh SI, Takeishi Y. Tricuspid and Mitral Valve Regurgitation with Bi-fascicular Block Following a Horse Kick. Intern Med 2018; 57:1597-1600. [PMID: 29321434 PMCID: PMC6028678 DOI: 10.2169/internalmedicine.9762-17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
A 40-year-old man was transferred to our hospital following an isolated horse kick injury to the anterior chest wall. The case showed bi-fascicular block, severe tricuspid valve regurgitation due to ruptured chordae tendineae of the anterior leaflet, moderate mitral valve regurgitation due to prolapse of mitral anterior leaflet, and hypokinetic motion of the inferior septal wall. Both tricuspid and mitral insufficiency were completely repaired by a surgical operation. Fortunately, these injuries were not fatal in this case, but the comprehensive assessment of cardiac damage and careful observation are important for managing patients with cardiac injury.
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Affiliation(s)
- Tomoki Kokubun
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | - Masayoshi Oikawa
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | - Yasuhiro Ichijo
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | | | - Tetsuro Yokokawa
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | - Kazuhiko Nakazato
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | - Yoshiyuki Sato
- Department of Cardiovascular Surgery, Fukushima Medical University, Japan
| | - Shinya Takase
- Department of Cardiovascular Surgery, Fukushima Medical University, Japan
| | - Hiroharu Shinjo
- Department of Cardiovascular Surgery, Fukushima Medical University, Japan
| | - Hitoshi Yokoyama
- Department of Cardiovascular Surgery, Fukushima Medical University, Japan
| | - Hitoshi Suzuki
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | - Shu-Ichi Saitoh
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
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27
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Verma N, White CS, Mohammed TL. Blunt Cardiothoracic Trauma: Common Injuries and Diagnosis. Semin Roentgenol 2018; 53:171-177. [PMID: 29861008 DOI: 10.1053/j.ro.2018.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Nupur Verma
- Department of Radiology, University of Florida, Gainesville, FL.
| | - Charles S White
- Department of Radiology, University of Maryland, Baltimore, MD
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29
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30
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Traumatic Coronary Artery Dissection with Secondary Acute Myocardial Infarction after Blunt Thoracic Trauma. J Belg Soc Radiol 2018; 102:4. [PMID: 30128419 PMCID: PMC6095083 DOI: 10.5334/jbr-btr.1379] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report the case of a 41-year-old male with traumatic coronary artery dissection after a high-speed motor vehicle collision. Computed tomography imaging revealed multiple intracranial subdural and subarachnoid bleedings, a skull base fracture and multiple bilateral rib fractures. There was no pericardial hemorrhage, haemothorax or pneumothorax. No intra-abdominal lesions were found. A 12-lead electrocardiogram on arrival showed an acute myocardial infarction. Emergency angiography showed complete dissection of the right coronary artery without reflow after placement of 6 coronary stents. The patient passed away the day after. In retrospective, the right coronary dissection was visible on the trauma CT-scan.
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31
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Patel AR, Caffarelli A, Pandian NG. Aortic Disorders. Echocardiography 2018. [DOI: 10.1007/978-3-319-71617-6_29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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32
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Saric P, Ravaee BD, Patel TR, Hoit BD. Acute severe mitral regurgitation after blunt chest trauma. Echocardiography 2017; 35:272-274. [PMID: 29226380 DOI: 10.1111/echo.13775] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Myocardial contusion and aortic injury are well-known cardiac complications of blunt chest trauma, but valvular injury is rare. Traumatic valve injuries most commonly involve the aortic valve, with isolated mitral valve injury being quite rare. We report a case of acute severe mitral regurgitation due to ruptured chordae tendineae requiring surgical repair following a motor vehicle accident.
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Affiliation(s)
- Petar Saric
- Department of Internal Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Benjamin D Ravaee
- Department of Cardiovascular Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Toral R Patel
- Department of Internal Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Brian D Hoit
- Department of Cardiovascular Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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33
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Eghbalzadeh K, Sabashnikov A, Zeriouh M, Choi YH, Bunck AC, Mader N, Wahlers T. Blunt chest trauma: a clinical chameleon. Heart 2017; 104:719-724. [DOI: 10.1136/heartjnl-2017-312111] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/23/2017] [Accepted: 11/03/2017] [Indexed: 02/05/2023] Open
Abstract
The incidence of blunt chest trauma (BCT) is greater than 15% of all trauma admissions to the emergency departments worldwide and is the second leading cause of death after head injury in motor vehicle accidents. The mortality due to BCT is inhomogeneously described ranging from 9% to 60%. BCT is commonly caused by a sudden high-speed deceleration trauma to the anterior chest, leading to a compression of the thorax. All thoracic structures might be injured as a result of the trauma. Complex cardiac arrhythmia, heart murmurs, hypotension, angina-like chest pain, respiratory insufficiency or distention of the jugular veins may indicate potential cardiac injury. However, on admission to emergency departments symptoms might be missing or may not be clearly associated with the injury. Accurate diagnostics and early management in order to prevent serious complications and death are essential for patients suffering a BCT. Optimal initial diagnostics includes echocardiography or CT, Holter-monitor recordings, serial 12-lead electrocardiography and measurements of cardiac enzymes. Immediate diagnostics leading to the appropriate therapy is essential for saving a patient’s life. The key aspect of the entire management, including diagnostics and treatment of patients with BCT, remains an interdisciplinary team involving cardiologists, cardiothoracic surgeons, imaging radiologists and trauma specialists working in tandem.
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34
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Carmichael SP, Bounds MC, Shafii AE, Chang PK. Emergency department repair of blunt right atrial rupture utilizing cardiopulmonary bypass. Trauma Case Rep 2017; 12:1-3. [PMID: 29644273 PMCID: PMC5887067 DOI: 10.1016/j.tcr.2017.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2017] [Indexed: 11/26/2022] Open
Abstract
Blunt cardiac injury (BCI) with free wall rupture carries a high risk of pre-hospital death. Cardiopulmonary bypass (CPB) has been utilized as a bridge to repair of cardiac lesions in select patients. We present an interesting case of emergency department repair of right atrial rupture with cardiopulmonary bypass.
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Affiliation(s)
- Samuel P. Carmichael
- General Surgery Residency Program, University of Kentucky College of Medicine, Lexington, KY, United States
- Corresponding author at: University of Kentucky, 800 Rose Street, C-234, Lexington, KY 40536-0298, United States.University of Kentucky800 Rose StreetC-234LexingtonKY40536-0298United States
| | - Michael C. Bounds
- General Surgery Residency Program, University of Kentucky College of Medicine, Lexington, KY, United States
| | - Alexis E. Shafii
- Division of Cardiothoracic Surgery, University of Kentucky College of Medicine, Lexington, KY, United States
| | - Phillip K. Chang
- Division of General Surgery – Section of Trauma and Critical Care, University of Kentucky College of Medicine, Lexington, KY, United States
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35
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Burrell AJ, Kaye DM, Fitzgerald MC, Cooper DJ, Hare JL, Costello BT, Taylor AJ. Cardiac magnetic resonance imaging in suspected blunt cardiac injury: A prospective, pilot, cohort study. Injury 2017; 48:1013-1019. [PMID: 28318537 DOI: 10.1016/j.injury.2017.02.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 02/16/2017] [Accepted: 02/23/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate the incidence and severity of blunt cardiac injury (BCI) as determined by cardiac magnetic resonance imaging (CMR), and to compare this to currently used diagnostic methods in severely injured patients. MATERIALS AND METHODS We conducted a prospective, pilot cohort study of 42 major trauma patients from July 2013 to Jan 2015. The cohort underwent CMR within 7 days, enrolling 21 patients with evidence of chest injury and an elevated Troponin I compared to 21 patients without chest injury who acted as controls. Major adverse cardiac events (MACE) including ventricular arrhythmia, unexplained hypotension requiring inotropes, or a requirement for cardiac surgery were recorded. RESULTS 6/21 (28%) patients with chest injuries had abnormal CMR scans, while all 21 control patients had normal scans. CMR abnormalities included myocardial oedema, regional wall motion abnormalities, and myocardial haemorrhage. The left ventricle was the commonest site of injury (5/6), followed by the right ventricle (2/6) and tricuspid valve (1/6). MACE occurred in 5 patients. Sensitivity and specificity values for CMR at predicting MACE were 60% (15-95) and 81% (54-96), which compared favourably with other tests. CONCLUSION In this pilot trial, CMR was found to give detailed anatomic information of myocardial injury in patients with suspected BCI, and may have a role in the diagnosis and management of patients with suspected BCI.
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Affiliation(s)
- Aidan Jc Burrell
- The Intensive Care Unit, Alfred Hospital, 55 Commercial Road, Melbourne 3181, VIC, Australia; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne 3004, VIC, Australia.
| | - David M Kaye
- The Department of Cardiovascular Medicine, Alfred Hospital, 55 Commercial Road, Melbourne 3181, VIC, Australia; BakerIDI Heart and Diabetes Institute, Melbourne, Australia
| | - Mark C Fitzgerald
- The Department of Trauma, Alfred Hospital, 55 Commercial Road, Melbourne 3181, VIC, Australia
| | - David J Cooper
- The Intensive Care Unit, Alfred Hospital, 55 Commercial Road, Melbourne 3181, VIC, Australia; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne 3004, VIC, Australia
| | - James L Hare
- The Department of Cardiovascular Medicine, Alfred Hospital, 55 Commercial Road, Melbourne 3181, VIC, Australia; BakerIDI Heart and Diabetes Institute, Melbourne, Australia
| | | | - Andrew J Taylor
- The Department of Cardiovascular Medicine, Alfred Hospital, 55 Commercial Road, Melbourne 3181, VIC, Australia; BakerIDI Heart and Diabetes Institute, Melbourne, Australia
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Bouabdallaoui N, Debbagh H, Schoell T, Lebreton G. Surgical Management of Undiagnosed Laceration of Superior Vena Cava Caused by Blunt Trauma. Ann Thorac Surg 2017; 101:1972-4. [PMID: 27106431 DOI: 10.1016/j.athoracsur.2015.07.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 07/14/2015] [Accepted: 07/15/2015] [Indexed: 11/25/2022]
Abstract
Intrapericardial rupture of the superior vena cava resulting from blunt thoracic trauma is a rare and life-threatening condition that has to be ruled out in the presence of signs of cardiac tamponade and a history of blunt thoracic trauma. We report the case of undiagnosed superior vena cava laceration caused by a high-speed road traffic accident in a 25 year-old patient revealed by cardiac tamponade. We highlight the need of urgent surgical exploration in all patients whose condition is unstable in the setting of blunt thoracic trauma regardless of imaging conclusions.
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Affiliation(s)
- Nadia Bouabdallaoui
- Department of Thoracic and Cardiovascular Surgery; Pierre et Marie Curie University, Paris VI; Assistance publique des hôpitaux de Paris, La Pitié Salpêtrière Hospital, Paris, France.
| | - Hassan Debbagh
- Department of Thoracic and Cardiovascular Surgery; Pierre et Marie Curie University, Paris VI; Assistance publique des hôpitaux de Paris, La Pitié Salpêtrière Hospital, Paris, France; Department of Thoracic and Cardiovascular Surgery, Fort de France University Hospital, Fort de France, Martinique, France
| | - Thibaut Schoell
- Department of Thoracic and Cardiovascular Surgery; Pierre et Marie Curie University, Paris VI; Assistance publique des hôpitaux de Paris, La Pitié Salpêtrière Hospital, Paris, France; Department of Thoracic and Cardiovascular Surgery, Fort de France University Hospital, Fort de France, Martinique, France
| | - Guillaume Lebreton
- Department of Thoracic and Cardiovascular Surgery; Pierre et Marie Curie University, Paris VI; Assistance publique des hôpitaux de Paris, La Pitié Salpêtrière Hospital, Paris, France
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Lee TL, Hsuan CF, Shih CH, Liang HW, Tsai HS, Tseng WK, Hsu KL. Early detection of myocardial infarction following blunt chest trauma by computed tomography: a case report. BMC Cardiovasc Disord 2017; 17:56. [PMID: 28183285 PMCID: PMC5301382 DOI: 10.1186/s12872-017-0496-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 02/07/2017] [Indexed: 11/15/2022] Open
Abstract
Background Blunt cardiac trauma encompasses a wide range of clinical entities, including myocardial contusion, cardiac rupture, valve avulsion, pericardial injuries, arrhythmia, and even myocardial infarction. Acute myocardial infarction due to coronary artery dissection after blunt chest trauma is rare and may be life threatening. Differential diagnosis of acute myocardial infarction from cardiac contusion at this setting is not easy. Case presentation Here we demonstrated a case of blunt chest trauma, with computed tomography detected myocardium enhancement defect early at emergency department. Under the impression of acute myocardial infarction, emergent coronary angiography revealed left anterior descending artery occlusion. Revascularization was performed and coronary artery dissection was found after thrombus aspiration. Finally, the patient survived after coronary stenting. Conclusion Perfusion defects of myocardium enhancement on CT after blunt chest trauma can be very helpful to suggest myocardial infarction and facilitate the decision making of emergent procedure. This valuable sign should not be missed during the initial interpretation.
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Affiliation(s)
- Thung-Lip Lee
- Division of Cardiology, Department of Internal Medicine, E-Da hospital / I-Shou University, Kaohsiung, Taiwan
| | - Chin-Feng Hsuan
- Division of Cardiology, Department of Internal Medicine, E-Da hospital / I-Shou University, Kaohsiung, Taiwan
| | - Chen-Hsiang Shih
- Division of Cardiology, Department of Internal Medicine, E-Da hospital / I-Shou University, Kaohsiung, Taiwan
| | - Huai-Wen Liang
- Division of Cardiology, Department of Internal Medicine, E-Da hospital / I-Shou University, Kaohsiung, Taiwan
| | - Hsing-Shan Tsai
- Division of Cardiology, Department of Internal Medicine, E-Da hospital / I-Shou University, Kaohsiung, Taiwan
| | - Wei-Kung Tseng
- Division of Cardiology, Department of Internal Medicine, E-Da hospital / I-Shou University, Kaohsiung, Taiwan.
| | - Kwan-Lih Hsu
- Department of Internal Medicine, E-Da cancer hospital / I-Shou University, Kaohsiung, Taiwan
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Du WH, Wang X, Xiong XQ, Li T, Liang HP. Role of speckle tracking imaging in the assessment of myocardial regional ventricular function in experimental blunt cardiac injury. Chin J Traumatol 2017; 18:223-8. [PMID: 26764544 DOI: 10.1016/j.cjtee.2014.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To evaluate the usefulness and information collecting ability of speckle tracking imaging techniques in the assessment of myocardial regional ventricular contractility in a rabbit model with blunt cardiac injury. METHODS Fifteen healthy New Zealand rabbits weighing (2.70 ±0.28) kg were anesthetized (3% pentobarbital sodium/i.v) and impacted using the BIM-II biological impact machine to induce myocardial contusion (MC). Hemodynamic parameters, such as heart rate, systolic pressure, mean arterial pressure, diastolic pressure and central venous pressure, were determined before and after MC. Further, parameters reflecting left ventricular functions, such as left ventricular end systolic pressure, left ventricular end diastolic pressure, isovolumic pressure (IP) and the maximal increasing/decreasing rate of left intraventricular pressure (±dp/dtmax), were also determined before and after MC. Left ventricular functions were determined either by two dimensional transthoracic echocardiography or by speckle tracking imaging for segmental abnormal ventricular wall motions. RESULTS Heart rate, systolic pressure, diastolic pressure and mean arterial pressure decreased significantly but transiently, while central venous pressure markedly increased after MC. In contrast to significant changes in diastolic functions, there was no significant change in cardiac systolic functions after MC. The speckle tracking imaging demonstrated that strain values of different myocardial segment significantly decreased post impact, and that of the ventricular segment decreased from segment to segment. CONCLUSION Speckle tracking imaging is useful and informative to assess myocardial regional dysfunctions post MC.
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Affiliation(s)
- Wen-Hua Du
- State Key Laboratory of Trauma, Burns, and Combined Injury, Department of Ultrasound, Daping Hospital and Research Institute of Surgery, the Third Military Medical University, Chongqing 40042, China
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Saranteas T, Mavrogenis AF, Mandila C, Poularas J, Panou F. Ultrasound in cardiac trauma. J Crit Care 2016; 38:144-151. [PMID: 27907878 DOI: 10.1016/j.jcrc.2016.10.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 10/31/2016] [Indexed: 11/17/2022]
Abstract
In the perioperative period, the emergency department or the intensive care unit accurate assessment of variable chest pain requires meticulous knowledge, diagnostic skills, and suitable usage of various diagnostic modalities. In addition, in polytrauma patients, cardiac injury including aortic dissection, pulmonary embolism, acute myocardial infarction, and pericardial effusion should be immediately revealed and treated. In these patients, arrhythmias, mainly tachycardia, cardiac murmurs, or hypotension must alert physicians to suspect cardiovascular trauma, which would potentially be life threatening. Ultrasound of the heart using transthoracic and transesophageal echocardiography are valuable diagnostic tools that can be used interchangeably in conjunction with other modalities such as the electrocardiogram and computed tomography for the diagnosis of cardiovascular abnormalities in trauma patients. Although ultrasound of the heart is often underused in the setting of trauma, it does have the advantages of being easily accessible, noninvasive, and rapid bedside assessment tool. This review article aims to analyze the potential cardiac injuries in trauma patients, and to provide an elaborate description of the role of echocardiography for their accurate diagnosis.
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Affiliation(s)
- Theodosios Saranteas
- Department of Anaesthesiology, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece.
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | - Christina Mandila
- Intensive Care Unit, General State Hospital of Athens, Athens, Greece
| | - John Poularas
- Intensive Care Unit, General State Hospital of Athens, Athens, Greece
| | - Fotios Panou
- Second department of Cardiology, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
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Pande A, Patra S, Jena M, Chakraborty R. Blunt traumatic dissection of right coronary artery presenting with acute inferior wall myocardial infarction: Dilemma in management. Indian Heart J 2016; 68 Suppl 2:S276-S279. [PMID: 27751314 PMCID: PMC5067800 DOI: 10.1016/j.ihj.2016.07.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 07/27/2016] [Indexed: 11/29/2022] Open
Abstract
Thirty-nine year male had a history of road traffic accident with polytrauma. At emergency room he started having chest pain with ventricular tachycardia. He was subsequentially diagnosed with right coronary artery dissection secondary to blunt trauma which is an extremely rare cause of inferior wall myocardial infarction. After some dilemmas, he was ultimately treated with intravascular ultrasound guided coronary angioplasty with stenting and had an uneventful recovery.
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Affiliation(s)
- Arindam Pande
- Department of Cardiology, Apollo Gleneagles Hospital, Kolkata, India.
| | - Soumya Patra
- Department of Cardiology, Apollo Gleneagles Hospital, Kolkata, India
| | - Manabhanjan Jena
- Department of Cardiology, Apollo Gleneagles Hospital, Kolkata, India
| | - Rabin Chakraborty
- Department of Cardiology, Apollo Gleneagles Hospital, Kolkata, India
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Karalis DG, Tortella BJ, Chandrasekaran K. Role of Transesophageal Echocardiography in Blunt Chest Trauma. Semin Cardiothorac Vasc Anesth 2016. [DOI: 10.1177/108925320200600210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients who suffer blunt chest trauma are at risk for injury to the heart, and the thoracic aorta and its branch vessels. Unrecognized injury to the heart or aorta may lead to life threatening complications. Therefore, the physician caring for the trauma patient must be able to accurately and rapidly diagnose cardiac and thoracic aortic injury. Transesophageal echocardiography is an ideal tool to diagnose cardiac and aortic injury in the patient with blunt chest trauma because it provides high quality images of the heart and thoracic aorta and can safely and rapidly be performed in the emergency department, operating suite or intensive care unit. To utilize transesophageal echocardiography most effectively, the echocardiographer must be familiar with the indications, limitations, and piffalls of transesophageal echocardiography in patients with blunt chesttrauma. This review describes the role of transesophageal echocardiography in evaluating the patient with blunt chest trauma for cardiac, thoracic aortic, and mediastinal injury.
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Affiliation(s)
- Dean G. Karalis
- Division of Cardiology, Drexel University College of Medicine, Philadelphia PA; Cardiology Consultants of Philadelphia, 227 North Broad Street, Suite 200, Philadelphia, PA 19107
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Sternal fractures and delayed cardiac tamponade due to a severe blunt chest trauma. Am J Emerg Med 2016; 34:758.e1-3. [DOI: 10.1016/j.ajem.2015.07.075] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 07/28/2015] [Indexed: 11/15/2022] Open
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Hall MK, Omer T, Moore CL, Taylor RA. Cost-effectiveness of the Cardiac Component of the Focused Assessment of Sonography in Trauma Examination in Blunt Trauma. Acad Emerg Med 2016; 23:415-23. [PMID: 26857839 DOI: 10.1111/acem.12936] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 11/01/2015] [Accepted: 11/02/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Blunt cardiac injury severe enough to require surgical intervention (sBCI) is an exceedingly rare event occurring in approximately 1 out of every 1600 trauma patients. While performing the cardiac component of the Focused Assessment of Sonography in Trauma (cFAST) exam is effective in penetrating trauma, it is unclear whether it is of value in blunt trauma given the low prevalence of sBCI, the imperfect test characteristics of the FAST exam, and the rate of incidental pericardial effusion. OBJECTIVE The objective was to determine through decision analysis whether performing the cFAST exam is cost-effective in the evaluation of hypotensive and normotensive blunt trauma patients. METHODS We created two decision analytic models using commercially available software (TreeAgePro2011) to evaluate the cost-effectiveness of the cFAST in hypotensive (systolic blood pressure <90 mm Hg) and normotensive blunt trauma patients. Clinical probabilities were obtained from published data. Costs were estimated from Medicare reimbursement and charge data. The willingness-to-pay threshold was $50,000/quality-adjusted life-years (QALYs). Sensitivity analyses were performed over plausible ranges using available literature. RESULTS In hypotensive patients, for the base case scenario of a 34-year-old with blunt trauma, the cFAST strategy had a cost of $42,882.70 and an effectiveness of 25.3597 QALYs, whereas the no cFAST strategy had a cost of $42,753.52 and an effectiveness of 25.3532 QALYs. The incremental cost-effectiveness ratio (ICER) was $19,918/QALY. For normotensive patients the cFAST strategy had a cost of $18,331.03 and an effectiveness of 23.2817 QALYs, whereas the no cFAST strategy had a cost of $18,207.58 and an effectiveness of 23.2814 QALYs. The ICER was $465,867/QALY. In the sensitivity analyses, age, probability of death from sBCI with prompt treatment, and probability of sBCI were the main drivers of variability in the model outcomes. CONCLUSIONS The cFAST for blunt trauma is cost-effective for hypotensive but not for normotensive patients. The ICER for hypotensive patients was more than 20 times higher than the ICER for normotensive patients. Our results suggest that performing the cFAST exam may not be an effective use of resources in normotensive blunt trauma patients.
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Affiliation(s)
- M. Kennedy Hall
- Division of Emergency Medicine; University of Washington School of Medicine; Seattle WA
- Department of Emergency Medicine; Yale University School of Medicine; New Haven CT
| | - Talib Omer
- Department of Emergency Medicine; Yale University School of Medicine; New Haven CT
| | - Chris L. Moore
- Department of Emergency Medicine; Yale University School of Medicine; New Haven CT
| | - R. Andrew Taylor
- Department of Emergency Medicine; Yale University School of Medicine; New Haven CT
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Muratsu A, Muroya T, Onoe A, Nakamura F, Wada D, Nakajima M, Iwamura H, Kishimoto M, Yui R, Sakuramoto K, Hayakawa K, Saito F, Nakamori Y, Kuwagata Y. Ventricular septal perforation after blunt chest trauma due to blows from a fist. Acute Med Surg 2016; 3:372-375. [PMID: 29123815 DOI: 10.1002/ams2.176] [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: 05/20/2015] [Accepted: 10/06/2015] [Indexed: 10/22/2022] Open
Abstract
Case A 40-year-old man received fist blows to his chest and abdomen. He presented with external jugular vein distention and facial congestion. Chest X-ray showed bilateral pulmonary congestion. A Levine V/VI holosystolic murmur was audible. Echocardiography showed left-to-right shunt flow across the perimembranous region of the ventricular septum. The diameter of the hole was approximately 13 mm. We diagnosed ventricular septal perforation, started an infusion, and administered vasopressors. However, circulatory dynamics could not be maintained. The ventricular septal perforation was repaired directly with mattress sutures through the right ventricle. A small residual ventricular septal perforation was detected, which was repaired with a patch sutured through the left ventricle. Outcome The patient was discharged without cardiovascular complications 43 days after admission. Conclusion Ventricular septal perforation following blunt chest trauma is a rare form of cardiac trauma. It is important to consider the timing of the operation and the best method to ensure cardiac repair.
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Affiliation(s)
- Arisa Muratsu
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Takashi Muroya
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Atsunori Onoe
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Fumiko Nakamura
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Daiki Wada
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Mari Nakajima
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Hiromu Iwamura
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Masanobu Kishimoto
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Rintaro Yui
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Kazuhito Sakuramoto
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Koichi Hayakawa
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Fukuki Saito
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Yasushi Nakamori
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
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Nam Lee S, Jin Noh H, Seung Kim S, Nam Y, Yoo KD. Postcardiac Injury Syndrome Following Acute Myocardial Infarction Related to Blunt Chest Trauma. Intern Med 2016; 55:251-4. [PMID: 26831018 DOI: 10.2169/internalmedicine.55.4420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Blunt chest trauma can cause acute myocardial infarction, which may also be associated with pericarditis. However, such cases are rare. We herein report a case of a 57-year-old man suffering from acute myocardial infarction due to a blunt chest trauma and postcardiac injury syndrome after discharge with spontaneous resolution of a total coronary occlusion.
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Affiliation(s)
- Su Nam Lee
- Department of Cardiovascular Medicine, St. Vincent's Hospital, The Catholic University of Korea, South Korea
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Baxi AJ, Restrepo C, Mumbower A, McCarthy M, Rashmi K. Cardiac Injuries: A Review of Multidetector Computed Tomography Findings. Trauma Mon 2015; 20:e19086. [PMID: 26839855 PMCID: PMC4727463 DOI: 10.5812/traumamon.19086] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Revised: 06/12/2014] [Accepted: 07/12/2014] [Indexed: 01/15/2023] Open
Abstract
Trauma is the leading cause of death in United States in the younger population. Cardiac trauma is common following blunt chest injuries and is associated with high morbidity and mortality. This study discusses various multidetector computed tomography (MDCT) findings of cardiac trauma. Cardiac injuries are broadly categorized into the most commonly occurring blunt cardiac injury and the less commonly occurring penetrating injury. Signs and symptoms of cardiac injury can be masked by the associated injuries. Each imaging modality including chest radiographs, echocardiography, magnetic resonance imaging and MDCT has role in evaluating these patients. However, MDCT is noninvasive; universally available and has a high spatial, contrast, and temporal resolution. It is a one stop shop to diagnose and evaluate complications of cardiac injury. MDCT is an imaging modality of choice to evaluate patients with cardiac injuries especially the injuries capable of causing hemodynamic instability.
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Affiliation(s)
- Ameya Jagdish Baxi
- Department of Radiology, University of Texas Health Science Center, San Antonio, USA
- Corresponding author: Ameya Jagdish Baxi, Department of Radiology, University of Texas Health Science Center, San Antonio, USA. Tel: +1-2105675535, E-mail:
| | - Carlos Restrepo
- Department of Radiology, University of Texas Health Science Center, San Antonio, USA
| | - Amy Mumbower
- Department of Radiology, University of Texas Health Science Center, San Antonio, USA
| | - Michael McCarthy
- Department of Radiology, University of Texas Health Science Center, San Antonio, USA
| | - Katre Rashmi
- Department of Radiology, University of Texas Health Science Center, San Antonio, USA
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de Biasi AR, Seastedt KP, Eachempati SR, Salemi A. Common Cause of Mortality in Trauma but Manageable Nonetheless. Circulation 2015; 132:537-45. [PMID: 26260499 DOI: 10.1161/circulationaha.115.016061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andreas R de Biasi
- From Department of Cardiothoracic Surgery, Division of Cardiac Surgery (A.R.d.B., A.S.), and Department of Surgery, Division of Burn, Critical Care, and Trauma Surgery (K.P.S., S.R.E.), Weill Cornell Medical College/New York-Presbyterian Hospital, New York
| | - K Patrick Seastedt
- From Department of Cardiothoracic Surgery, Division of Cardiac Surgery (A.R.d.B., A.S.), and Department of Surgery, Division of Burn, Critical Care, and Trauma Surgery (K.P.S., S.R.E.), Weill Cornell Medical College/New York-Presbyterian Hospital, New York
| | - Soumitra R Eachempati
- From Department of Cardiothoracic Surgery, Division of Cardiac Surgery (A.R.d.B., A.S.), and Department of Surgery, Division of Burn, Critical Care, and Trauma Surgery (K.P.S., S.R.E.), Weill Cornell Medical College/New York-Presbyterian Hospital, New York
| | - Arash Salemi
- From Department of Cardiothoracic Surgery, Division of Cardiac Surgery (A.R.d.B., A.S.), and Department of Surgery, Division of Burn, Critical Care, and Trauma Surgery (K.P.S., S.R.E.), Weill Cornell Medical College/New York-Presbyterian Hospital, New York.
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Granda Nistal C, Rubio Alonso B, Mejía Martínez E, Blázquez Arroyo L, Coto Morales B, Parra Fuertes JJ, García Tejada J, Hernández Hernández F, Velázquez Martín MT, González-Trevilla AA. Left Main Dissection and Pseudoaneurysm Formation After a Road Traffic Accident. Circulation 2015; 132:e143-5. [PMID: 26371239 DOI: 10.1161/circulationaha.115.014515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Belén Rubio Alonso
- From Cardiology Department, University Hospital 12 de Octubre, Madrid, Spain
| | | | | | - Blanca Coto Morales
- From Cardiology Department, University Hospital 12 de Octubre, Madrid, Spain
| | | | - Julio García Tejada
- From Cardiology Department, University Hospital 12 de Octubre, Madrid, Spain
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Fatal right coronary artery rupture following blunt chest trauma: detection by postmortem selective coronary angiography. Int J Legal Med 2015; 130:759-63. [PMID: 26126482 DOI: 10.1007/s00414-015-1215-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 06/11/2015] [Indexed: 10/23/2022]
Abstract
Coronary artery injury is a rare complication following blunt chest trauma (BCT), and can be fatal. Here we report findings on postmortem selective coronary angiography of right coronary artery rupture after an assault involving blunt trauma to the chest. A woman in her 60s died after her son stomped on her chest. There were no appreciable signs of injury on external examination, and cause of death could not be determined by postmortem computed tomography (PMCT). Internal findings indicated that an external force had been applied to the anterior chest, as evidenced by subcutaneous hemorrhage and pericardial and cardiac contusions. Postmortem coronary angiography revealed irregularity of the intima and of the fat tissue surrounding the proximal part of the right coronary artery associated with a local filling defect. Histopathological examination suggested coronary rupture with dissection of the tunica media and compression of the lumen cavity. The key points in the present case are that no fatal injuries could be determined on external examination, and the heart and coronary artery injuries were not evident on PMCT. Criminality might be overlooked in such cases, as external investigation at the crime scene would be inadequate and could result in a facile diagnosis of cause of death. This is the first report of coronary artery rupture with dissection that was detected by CT coronary angiography, and provides helpful findings for reaching an appropriate decision both forensically and clinically.
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