Cases reported "Heart Injuries"

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1/9. Simultaneous papillary muscle avulsion and free wall rupture during acute myocardial infarction. Intra-aortic balloon pump: a bridge to survival.

    Mechanical complications of acute myocardial infarction (AMI) are rare, but often fatal. Medical therapy does not provide adequate risk reduction, and surgical correction is recommended when feasible. Supplemental hemodynamic support utilizing intra-aortic counterpulsation with a balloon pump provides an improvement in morbidity and mortality when combined with a corrective surgical approach. We report a case of an elderly male with a progressive 2-week history of ischemic symptoms presenting with acute pulmonary edema, hypotension and an inferior wall ST-elevation MI. His hospital course was complicated by ischemic mitral regurgitation (MR) and cardiogenic shock, which resulted in a papillary muscle rupture/avulsion from the inferolateral myocardial wall, and a communication for blood from ventricle to pericardial space. Initial management included mechanical ventilation, pharmacologic inotropic support, percutaneous revascularization of the culprit lesion and intra-aortic balloon counterpulsation. The patient underwent further successful cardiovascular surgical correction of his incompetent mitral valve, free wall rupture and other obstructive coronary arteries, leading to discharge and survival. Mechanical complications from AMI and the role of intra-aortic balloon support are discussed.
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2/9. Traumatic intracardiac communication: detection by color flow mapping.

    A previously healthy 20-year-old man underwent emergency surgery for repair of a right ventricular free wall laceration that was the result of a knife wound. A systolic murmur was first heard 1 month later, and two-dimensional echocardiography and color flow mapping demonstrated a communication between the left and right ventricle in the region of the membranous septum. The visualized turbulent flow was consistent with a ventriculoseptal defect but also appeared to extend posteriorly into the left atrium in a direct line with the septal communication. At cardiac catheterization the calculated left-to-right shunt was 1.2:1.
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3/9. Right sinus of valsalva-right atrial fistula secondary to nonpenetrating chest trauma: a case report with description of noninvasive diagnostic features.

    A sinus of valsalva-right atrial fistula secondary to nonpenetrating chest trauma is described. Echocardiogrpahy demonstrated diastolic fluttering of the anterior tricuspid valve, suggesting a left-to-right shunt at the level of the right atrium. External jugular venous pulse tracings revealed large alpha waves and attenuation of the y descent. cardiac catheterization disclosed a fistulous communication between the right sinus of valsalva and right atrium. After surgical repair of the fistula, the ultrasonic recording and external pulse tracing reverted to normal. We believe this is the first description of such a shunt after blunt thoracic trauma.
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4/9. Radionuclide diagnosis of cerebrospino-pericardial communication after ventriculoatrial catheter placement for hydrocephalus.

    A 1-month-old male child with a previously placed ventriculoatrial catheter presented with severe cardiorespiratory distress secondary to cardiac tamponade. A cerebrospino-pericardial communication from right atrial perforation by the catheter was diagnosed quickly and easily by a radionuclide injection of the proximal shunt reservoir.
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5/9. Traumatic right coronary artery--right atrial fistula.

    Traumatic coronary artery fistulae and intracardiac shunts due to penetrating wounds of the heart are rare, with only 19 reported cases in the literature. The communication, which may involve one or both coronary arteries, is classified into two major types depending on whether the drainage is into the left or right heart. We report a right coronary artery (RCA) right atrial fistula (RA) secondary to shrapnel injury in 1944.
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6/9. Left ventricular to right atrial defect and tricuspid insufficiency secondary to nonpenetrating cardiac trauma.

    We present a report of a 28-year-old male patient who developed a left ventricular to right atrial communication associated with tricuspid insufficiency secondary to nonpenetrating cardiac trauma. The patient's heart block was clarified by serial observation of electrocardiograms and the use of HIS bundle electrocardiography. The patient's fistula was surgically repaired, and 20 months postinjury he is asymptomatic and pacemaker dependent. echocardiography may aid in the early diagnosis of a left to right shunt and/or tricuspid insufficiency in the setting of possible cardiac trauma.
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7/9. Atrioventricular fistula: an unusual complication of endomyocardial biopsy in a heart transplant recipient.

    Endomyocardial biopsy remains the primary method for diagnosis of cardiac allograft rejection. Generally, endomyocardial biopsy is considered a relatively safe procedure in heart transplant recipients. Complications that have been reported are related to catheter insertion and include carotid arterial puncture, prolonged bleeding, vasovagal reaction, ventricular tachyarrhythmias, and transient conduction abnormalities. Serious complications such as right ventricular perforation with cardiac tamponade may also occur. Most complications are usually without significant long-term sequelae. This report describes an unusual case of atrioventricular fistula between the right atrium and left ventricle that occurred during a routine endomyocardial biopsy in a heart transplant recipient. Sudden hemodynamic compromise developed in this patient soon after heart biopsy associated with hemodynamic picture of high-output heart failure. Right heart catheterization, including oximetry, peripheral venous contrast echocardiography, color flow Doppler studies, and transesophageal echocardiography confirmed the diagnosis of fistulous communication between the right atrium and left ventricle, most likely through the membranous interventricular septum. Conservative medical management resulted in striking clinical improvement within 48 hours commensurate with spontaneous closure of the right atrium-to-left ventricle fistula documented by hemodynamic and echocardiographic studies.
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8/9. Acquired left ventricular to right atrial communication and complete heart block following nonpenetrating cardiac trauma.

    Intracardiac shunts are uncommon cardiac lesions caused by blunt chest trauma. A very unusual case is reported of a young male with an acquired left ventricular to right atrial communication and complete heart block cause by nonpenetrating chest trauma. The left ventricular to right atrial fistula was diagnosed noninvasively by transthoracic and transesophageal echo-Doppler examination and the findings were confirmed by left ventriculography and by the intraoperative findings.
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9/9. Posttraumatic left ventricular pseudoaneurysm due to intramyocardial dissecting hematoma.

    A left ventricular aneurysm can develop in patients sustaining blunt chest injury. This condition has been attributed to myocardial contusion or to a direct vascular lesion leading to myocardial necrosis. We report the case of a pseudoaneurysm resulting from myocardial dissection beginning from a small tear in the endocardial wall. Successful surgical exclusion of the pseudoaneurysm by endoaneurysmal patch closure of the communications between the aneurysm and the left ventricular cavity is described.
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