1/134. Coronary dissection and myocardial infarction following blunt chest trauma.myocardial infarction (MI) following blunt chest trauma is rarely diagnosed because the ensuing cardiac pain is commonly attributed to contused myocardium or the traumatic injuries in the local chest wall. There are only scattered reports on the coronary pathology associated with MI secondary to blunt chest trauma. Because differentiation of the pathology is difficult but important, we report here three cases of acute anterior MI secondary to coronary dissection following blunt chest trauma. Coronary dissection was demonstrated by coronary angiography. Two of the patients had intimal tears at the proximal left anterior descending artery (LAD) with normal flow, and the other patient had nearly total occlusion of the LAD associated with filling defects probably caused by an intracoronary thrombus. All three patients received conservative treatment without major complications and remained free from angina or heart failure throughout a 5-year follow-up period. In order to exclude associated MI in cases of blunt chest trauma, electrocardiography is necessary, and coronary angiography may be indicated to demonstrate coronary arterial pathology. dissection of the coronary artery with subsequent thrombus formation is one of the possible pathophysiologic mechanisms of MI following blunt chest trauma.- - - - - - - - - - ranking = 1keywords = coronary (Clic here for more details about this article) |
2/134. Traumatic dissection of the common carotid artery after blunt injury to the neck.BACKGROUND: Occlusive lesions of the common carotid artery (CCA) resulting from blunt injury are extremely rare, and their clinicopathologic and therapeutic features have not yet been clarified. OBJECTIVES AND RESULTS: Five patients with occlusive lesions of the CCA developed neurologic deficits at 1.5 hours to 10 years after blunt neck injury. Lesions included two complete occlusions, one severe stenosis, and two segmental intimal dissections of the CCA. In the two patients with CCA occlusion, bypass surgery was performed using a Dacron graft between the ipsilateral subclavian artery and the carotid bifurcation. In the remaining three patients, the involved segments were replaced with a Dacron graft. Surgical specimens from the early posttraumatic period revealed intimal tears with mural thrombosis and/or subintimal hematomas and those from the later period showed myointimal hyperplasia or fibrotic organization. CONCLUSION: Traumatic occlusive lesions of the CCA tend to evolve from intimal dissections to severe stenoses or occlusion, compromising cerebral circulation. The involved CCA can be diagnosed early by B-mode Doppler sonography and successfully reconstructed using a Dacron graft.- - - - - - - - - - ranking = 0.010054910286052keywords = circulation (Clic here for more details about this article) |
3/134. Traumatic rupture of the aortic valve and ascending aorta diagnosed by transesophageal echocardiography.The most common site for rupture of the aorta as a consequence of blunt chest trauma is at the level of the isthmus. rupture of the aortic valve with concomitant rupture of the ascending aorta is an uncommon entity and only relatively few patients sustaining such an injury survive to surgery. early diagnosis of such injuries are critical to facilitate timely intervention. We report a case of a 17-year old male who sustained a rupture left coronary cusp and ascending aorta in a road traffic accident. The diagnosis was preoperatively made by transesophageal echocardiography and he underwent successful surgical repair with primary apposition of the torn cusp and closure of the aorta with a pericardial patch. Preoperative diagnosis of this rare combination of injury has hitherto not been made by transesophageal echocardiography.- - - - - - - - - - ranking = 0.14285714285714keywords = coronary (Clic here for more details about this article) |
4/134. compartment syndromes.A patient is presented who developed the Compartment Syndrome, following blunt trauma to the lower limb. A "fibulectomy-fasciotomy" was performed. This allowed restoration of normal peripheral circulation of the limb but failed to prevent ischaemic necrosis developing in the anterior tibial, peroneal and posterior tibial compartments. compartment syndromes in the lower limb are discussed, with a view to their early recognition and management.- - - - - - - - - - ranking = 0.010054910286052keywords = circulation (Clic here for more details about this article) |
5/134. Dangerous impact--commotio cordis.Sudden death following blunt chest trauma is a frightening occurrence known as 'commotio cordis' or 'concussion of the heart'. It is speculated that commotio cordis could be caused by ventricular fibrillation secondary to an impact-induced energy that was transmitted via the chest wall to the myocardium during its vulnerable repolarization period. We describe a survivor of commotio cordis caused by a baseball. In this patient, an initial ventricular fibrillation was documented and converted by direct current defibrillation. Serial electrocardiographic changes (bifascicular conduction block and T wave inversion in precordial leads) were noticed in this patient. Our case suggested that coronary vasospasm might also play a role in commotio cordis.- - - - - - - - - - ranking = 0.14285714285714keywords = coronary (Clic here for more details about this article) |
6/134. Right coronary artery occlusion caused by blunt trauma.We describe the diagnostic and management dilemmas faced in the case of a thirty-year-old woman without a prior cardiac history, who after a motor vehicle accident, was found to have persistent EKG changes in the inferior leads consistent with an acute injury pattern. The patient was ultimately thought to have trauma and subsequent occlusion of the right coronary artery.- - - - - - - - - - ranking = 0.71428571428571keywords = coronary (Clic here for more details about this article) |
7/134. indocyanine green angiographic findings in 3 patients with traumatic hypotony maculopathy.PURPOSE: Little is known about the choroidal circulation in human eyes with ocular hypotony. Recently, indocyanine green angiography (IA) became a useful method for examining choroidal circulation. The present study using IA was designed to determine choroidal circulatory disturbances in patients with traumatic hypotony maculopathy. methods: indocyanine green angiography was performed on 3 consecutive patients (3 eyes) with traumatic hypotony. One patient underwent IA using an infrared fundus camera only during the hypotony stage. The other 2 patients underwent IA using a scanning laser ophthalmoscope before and after recovery of intraocular pressure (IOP). RESULTS: During the hypotony stage, IA revealed multiple hypofluorescent spots in many parts of the fundus, sector hypofluorescent areas, dilatation, and tortuosity of the choroidal vessels in the posterior pole. These findings had not been detected by fluorescein angiography. After surgical treatment, IOP returned to the normal range and visual acuity improved. indocyanine green angiography showed improvement of the sector hypofluorescent areas, and dilatation and tortuosity of choroidal vessels in the posterior pole. However, most of the hypofluorescent spots and regional delay of choroidal filling remained. CONCLUSIONS: indocyanine green angiography revealed that choroidal circulatory disturbances occurred during the hypotony stage and that some remained during the recovery stage.- - - - - - - - - - ranking = 0.020109820572104keywords = circulation (Clic here for more details about this article) |
8/134. Late cardiac arrhythmias after blunt chest trauma.OBJECTIVE: case reports of two patients who developed fatal cardiac arrhythmias several days after blunt chest trauma. DESIGN: case reports. SETTING: Surgical intensive care unit of a university hospital. patients: A 23-year-old man and a 9-year-old girl with blunt chest trauma and multiple further injuries following car crashes were transferred to our institution. Although ECG on admission was normal, both patients developed fatal cardiac arrhythmias after 6 and 4 days, respectively. In both patients, post-mortem analysis confirmed myocardial contusion without coronary artery lesions. Histological findings included severe interstitial oedema, haemorrhages and infiltration of lymphocytes and neutrophils, fresh myocardial necrosis and fatty degeneration. CONCLUSION: Blunt chest trauma with myocardial contusion may lead to fatal cardiac arrhythmias even after several days, particularly when other severe injuries are present. Thus, a normal ECG on admission and absence of cardiac arrhythmias during the first 24 h of intensive care treatment do not necessarily exclude the occurrence of life-threatening arrhythmias in the further course.- - - - - - - - - - ranking = 0.14285714285714keywords = coronary (Clic here for more details about this article) |
9/134. Cardiac and great vessel injuries in children after blunt trauma: an institutional review.PURPOSE: The purpose of this study was to review the incidence of cardiac and great vessel injury after blunt trauma in children. METHOD: A retrospective review of 2,744 patients with injuries from blunt mechanisms was performed. RESULTS: Eleven patients sustained cardiac injury. Four patients had clinically evident cardiac contusions. All recovered. Four patients who died from central nervous system injury were found to have cardiac contusions at autopsy. None had clinical evidence of contusion before demise. One patient had a traumatic ventricular septal defect (VSD) that required operative repair. autopsy findings showed a VSD in another patient, and a third patient was found to have a ventricular septal aneurysm that was treated medically. Two patients had great vessel injuries. One patient had a contained disruption of the superior vena cava that was managed nonoperatively. Another patient had a midthoracic periaortic hematoma without intimal disruption found at autopsy. One patient had cardiac and great vessel injuries. Discrete aneurysms of 2 coronary artery branches and the pulmonary outflow tract were identified by cardiac catheterization. This patient was treated nonoperatively. CONCLUSIONS: Cardiac and great vessel injury after blunt trauma are uncommon in children. Cardiac contusion was the most common injury encountered but had minimal clinical significance. Noncontusion cardiac injury is rare. No patient with aortic transection was identified.- - - - - - - - - - ranking = 0.14285714285714keywords = coronary (Clic here for more details about this article) |
10/134. rupture of the coronary artery after blunt nonpenetrating chest wall trauma detected by color Doppler echocardiography: a case report.We report a rare case of a ruptured papillary muscle of the anterior leaflet of the tricuspid valve and the rupture of the septal branch of the left anterior descending coronary artery with drainage into the right ventricle after blunt nonpenetrating chest wall trauma. Both abnormalities were detected by transthoracic 2-dimensional and color Doppler echocardiography, and the septal branch rupture was confirmed by coronary angiography. The leading echocardiographic sign of the rupture of the coronary artery was intramyocardial mosaic-colored flow, representing the turbulent high-velocity flow in the ruptured coronary artery. Hypokinesis of the anteroseptal myocardial segments and the presence of Q waves in leads V1 through 4 on the electro-cardiogram were suggestive of anteroseptal myocardial infarction. We conclude that the history of chest trauma, the electrocardiographic changes, and wall motion abnormalities should be stimuli for a careful color Doppler flow "mapping" of the myocardium for possible identification of a coronary artery rupture.- - - - - - - - - - ranking = 1.2857142857143keywords = coronary (Clic here for more details about this article) |
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