1/21. Traumatic pericardial hematoma simulating tricuspid valve obstruction.A large pericardial hematoma caused profound hypoxia, cyanosis, and hypotension in a patient who had sustained trauma in an automobile accident. Angiographic and cardiac catheterization findings suggested intracardiac obstruction at the level of the tricuspid valve. This case emphasizes that localized accumulations of blood or fluid within the pericardial space can simulate intracardiac masses or valve obstruction. Partial pericardiectomy was curative in this patient.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
2/21. Circumflex coronary artery occlusion after blunt chest trauma.A 32-year-old white male police officer suffered blunt trauma to the anterior chest wall during a routine training session. This was accompanied by the precipitous onset of chest discomfort. There was no previous history of any cardiac risk factors. The diagnosis of an inferior wall myocardial infarction was made based on the electrocardiogram findings, at his local community hospital. The total creatine kinase, creatine kinase-MB, and troponin i were normal. The transesophageal echocardiogram performed at that time demonstrated no aortic or coronary dissection. He was transferred to our tertiary care center. Emergency cardiac catheterization demonstrated lateral wall hypokinesis with a left ventricular ejection fraction of 45% and a total occlusion of the left circumflex coronary artery in its proximal portion. This was successfully recannulized with angioplasty and stenting techniques. We believe this to be only the second reported case of circumflex coronary artery obstruction after blunt chest trauma.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
3/21. Traumatic tricuspid regurgitation.Tricuspid valvular insufficiency caused by blunt thoracic trauma may be clinically silent and imprecise. Diagnosis is often done by cardiac catheterization and two-dimensional echocardiography (2-DE); the latter may show abnormalities of the tricuspid leaflet motion. The surgical technique for its correction is still controversial. We report here the case of an eighteen year old man who was involved in a high-speed motorcycle accident. Seven months later, due to dyspnoea and fatigue, 2D-E examination revealed cardiac enlargement and severe tricuspid regurgitation. Surgery was indicated in order to repair valve incompetence. Reinsertion of the chordae tendineae at the anterolateral papillary muscle and annuloplasty was performed and ten months postoperatively, he is in good clinical condition and 2D-E control shows a trivial residual tricuspid insufficiency.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
4/21. delayed diagnosis of post-traumatic acute myocardial infarction complicated by congestive heart failure.A 53-year-old man experienced persistent chest pain followed by slight shortness of breath after being hit in the chest by a stranger. Chest X-ray study showed no rib fractures but electrocardiography indicated acute anterior wall myocardial infarction. echocardiography revealed akinesia in both the interventricular septum and anterior left ventricular wall. Emergency cardiac catheterization demonstrated total occlusion of the proximal left anterior descending coronary artery, 9 h after the event. He was successfully treated with coronary angioplasty and stenting procedures. However, poor left ventricular function was observed 3 months after the event despite medications. We conclude that evaluation for possible myocardial injury should be considered soon after blunt chest trauma for early treatment to improve prognosis.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
5/21. Ruptured aneurysm of the noncoronary sinus of valsalva.sinus of valsalva aneurysm is a rare disorder. It is usually congenital, but other origins have been described. It may be asymptomatic, or it may present as angina or with symptoms of valvular insufficiency or outflow obstruction. Once ruptured, it often produces hemodynamic instability. Diagnosis should be pursued with transesophageal echocardiography or catheterization. A 50-year-old man was admitted with symptoms of congestive heart failure. His functional capacity had declined over 3 years, worsening over the last 3 weeks. His medical history was significant only for gunshot to the right hemithorax, at age 25. He was found to be in distress, with signs of heart failure, S3 and S4 gallop, and systolic and diastolic murmur at the right sternal border. Two-dimensional echocardiography revealed an ejection fraction of 0.25, dilated left and right atria, and a sinus of Valsalva aneurysm with an aortic-right atrial shunt. Left and right heart catheterization revealed metallic fragments in the anterior chest wall, normal coronary arteries, and a step-up in the oxygen saturation from the inferior vena cava to the pulmonary artery. aortography revealed that the aneurysm had ruptured into the right atrium. Surgical repair was performed. Ruptured sinus of valsalva aneurysm demands prompt diagnosis and treatment. patients are often men, in the 3rd or 4th decade of life when rupture occurs. In our patient, the position of the bullet and its fragments, leaflet perforation, and lack of a predisposing infection suggest a causal association between the gunshot wound and the aneurysm.- - - - - - - - - - ranking = 2keywords = catheterization (Clic here for more details about this article) |
6/21. Interventricular septum rupture due to falling from a height.Non-penetrating traumatic interventricular septal rupture of the heart is rare. This lesion can result from blunt injuries, either immediate or delayed, but has never been reported from blunt chest trauma secondary to falling from height. Surgical repair can usually be done as an elective procedure with good results. However, with some patients early repair is necessary as a lifesaving measure. We report on a 15-year-old patient admitted after falling from the fourth floor with multiple bone fractures and blood pressure of 80/0. He soon required mechanical ventilation, but a heart murmur was only detected after some hours. On the fifth day a non-penetrating traumatic interventricular septal rupture became apparent, which was proved by echocardiography and Swan-Ganz catheterization. The patient underwent successful repair of the interventricular septal defect on the 13th day following injury. Two weeks later surgery for his bone fractures was carried out, after which the patient could be discharged uneventfully.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
7/21. Delayed presentation of pericardial pseudocyst following blunt chest trauma.An unusual presentation of blunt chest trauma is reported. A 21-year-old man presented with symptoms and signs of congestive cardiac failure. 2D echocardiogram showed a thickened pericardium with a mass compressing the right ventricle. CT scan revealed a large mass anterior and to the right of the heart with evidence of pericardial thickening and calcification. However, its delineation from the pericardium and its exact tissue characterization were not possible. cardiac catheterization showed elevation and equalization of diastolic pressures in all cardiac chambers with characteristic waveforms suggestive of pericardial constriction. The precise definition and characterization of the mass was obtained only on magnetic resonance imaging (MRI) of the chest which showed it to be a solid, well encapsulated, partially calcified mass between the heart and the diaphragm extending anteriorly and to the right of the right ventricle. These findings were confirmed at the time of thoracotomy. Histopathology revealed blood clots and hyalinised fibrous tissue without any evidence of granuloma or malignancy. This report highlights an insiduous, late presentation of blunt chest trauma. It also demonstrates the superiority of MRI over computed X-ray tomography for mediastinal paracardiac masses.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
8/21. Ventricular aneurysm due to blunt chest injury.A left ventricular aneurysm developed in 3 patients sustaining blunt chest injury. Evidence of an acute myocardial infarction on the electrocardiogram and enzyme analysis prompted cardiac catheterization, which revealed total occlusion of the left anterior descending coronary artery in 2 of the 3 patients. Ventricular aneurysmectomy was performed in each patient. A review of the literature revealed 32 previously reported patients with left ventricular aneurysm caused by blunt trauma. Clinical features, catheterization or autopsy findings, and outcome are examined.- - - - - - - - - - ranking = 2keywords = catheterization (Clic here for more details about this article) |
9/21. Coronary artery dissection secondary to blunt chest trauma.A 38-yr-old woman presented with an anterolateral myocardial infarction following blunt chest trauma sustained in a motor vehicle accident. Subsequent cardiac catheterization revealed a large left ventricular aneurysm and angiographic evidence of dissection of the proximal left anterior descending artery. review of the literature and management are discussed.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
10/21. An unusual cause of mitral incompetence: post-traumatic paraprosthetic mitral incompetence.Nonpenetrating chest trauma, particularly that involving high-speed, may cause a variety of cardiac and aortic injuries. Cardiac valvular disruption following trauma is uncommon. Two cases of paraprosthetic mitral incompetence following blunt chest trauma are presented to document this entity and to discuss its investigation and management. Clinical examination and a high index of suspicion are foremost in making the diagnosis. Noninvasive tests may not confirm clinical diagnosis and cardiac catheterization has provided confirmation of clinical diagnosis.- - - - - - - - - - ranking = 1keywords = catheterization (Clic here for more details about this article) |
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