1/13. 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 = 1keywords = vessel (Clic here for more details about this article) |
2/13. heart luxation through a right-sided traumatic pericardial defect.A traumatic defect of the pericardium is a rarely diagnosed entity. We present a patient with a right-sided luxation of the heart which was incidentally diagnosed during a thoracic CT performed for other reasons. Despite of the threatening strangulation of the great vessels, the patient had a stable circulation until surgical repair of the pericardial defect.- - - - - - - - - - ranking = 0.125keywords = vessel (Clic here for more details about this article) |
3/13. Sudden death from myocardial contusion following an isolated blunt force trauma to the chest.Cardiac contusion is a common concomitant injury in blunt, non-penetrating chest trauma and is mostly a benign disorder which remains undiagnosed. In the case presented, a young man sustained a single blunt trauma to the chest from falling pieces of a wooden wheel and died at the scene. Among other findings, the autopsy revealed a circumscribed detachment of the coronary arteries on the anterior side of the heart. The most unusual findings were lacerations of the vessel wall layers in these areas which could already be seen at the autopsy and were proven by histological examination.- - - - - - - - - - ranking = 0.125keywords = vessel (Clic here for more details about this article) |
4/13. Delayed presentation of left ventricular outflow tract aneurysm after penetrating cardiac trauma.We report a case of posttraumatic left ventricular outflow tract aneurysm in a patient who had a stab injury to the chest requiring emergency operation 40 years previously. After apparent decades without symptoms, the patient presented with exertional dyspnea. Clinical and echocardiographic assessment revealed aortic regurgitation and left ventricular outflow tract aneurysm. Injuries to the chest wall that penetrate the heart and great vessels are life-threatening and require emergency operative intervention. However, these injuries rarely, as in this case, result in chronic cardiac aneurysm and aortic valvular incompetence.- - - - - - - - - - ranking = 0.125keywords = vessel (Clic here for more details about this article) |
5/13. Endovascular repair of accidental ligation of the right coronary artery during cardiorrhaphy for penetrating heart wound.We report a patient with a cardiac penetrating wound who underwent cardiorrhaphy which resulted in accidental ligation of the proximal right coronary artery (RCA), producing a postoperative acute inferior wall myocardial infarction. Although the option of surgical relief of the suture over the RCA was discussed, a repeat operation was considered to be of very high risk. Therefore, an endovascular attempt to recanalize the vessel was chosen. The external constriction around the RCA was successfully relieved with percutaneous transluminal coronary angioplasty (PTCA) and stenting. To our knowledge, this particular situation has not yet previously been published.- - - - - - - - - - ranking = 0.125keywords = vessel (Clic here for more details about this article) |
6/13. Case report: the management of penetrating cardiac trauma with major coronary artery injury--is cardiopulmonary bypass essential?Major coronary artery injury in penetrating cardiac trauma is relatively uncommon and is associated with a poor prognosis. However, for a variety of reasons, the outcome for such patients has been improving during the last two decades. The main factor responsible for this change is, according to some authors, the use of emergency cardiopulmonary bypass (CPB). We present a case of complete transection of the LAD coronary artery managed by primary ligation of the vessel, but because of progressive signs of extensive myocardial infarction, the patient underwent emergency CPB and an aortocoronary bypass graft. The patient experienced a good cardiac recovery but died 5 days later of irreversible anoxic brain damage. In reviewing the literature concerning the absolute need for emergency CPB in the management of penetrating coronary artery injury (PCAI), we found that the overall outcome for patients treated with emergency CPB was not significantly better than for those treated with ligation alone. We believe that CPB is not always essential in the management of PCAI and should be instituted only when the injury to a main coronary artery is very proximal, whenever associated intracardiac injuries exist, or when the patient develops extensive myocardial infarction or uncontrolled arrhythmias following ligation of the injured coronary vessel.- - - - - - - - - - ranking = 0.25keywords = vessel (Clic here for more details about this article) |
7/13. Traumatic innominate artery disruption and aortic valve rupture.Rapid deceleration injury causing blunt thoracic trauma can result in injury to the thoracic aorta. rupture of the aortic isthmus is the most common presentation; however, injury can occur more proximally in the arch vessels or the aortic root. We present an unusual case of simultaneous innominate artery disruption with aortic valve rupture after a motor vehicle accident, and we discuss issues surrounding the diagnosis and operative management of this rare, but life-threatening condition.- - - - - - - - - - ranking = 0.125keywords = vessel (Clic here for more details about this article) |
8/13. Kirschner wire migration from the pelvis to the heart and a new method of fixation of articular fracture fragments, acetabular reconstruction.Fixation of comminuted, articular fracture fragments is frequently difficult. This can be accomplished with Kirschner wires (K-wires), but the risk of migration of smooth K-wires is well known. A case of migration of such a wire from the acetabulum, through the great vessels, and into the heart is presented. The Herbert screw is designed to be "buried" and, thus, allows firm fixation and congruent reduction of overlying fragments. The variation in thread pitch between the two ends of the Herbert screw should prevent migration once the screw is seated. A use of the Herbert screw in the fixation of articular fracture fragments in acetabular reconstruction is presented.- - - - - - - - - - ranking = 0.125keywords = vessel (Clic here for more details about this article) |
9/13. Pericardial tamponade and hemothorax after penetrating injury to the internal mammary artery.Penetrating wounds to the anterior chest wall are associated with injury to the heart and great vessels. If injury to these structures is suspected, early surgical intervention is indicated. The internal mammary artery also can be involved in penetrating trauma and can present a clinical situation similar to heart injury, as in the case reported.- - - - - - - - - - ranking = 0.125keywords = vessel (Clic here for more details about this article) |
10/13. The role of coronary artery injury and perfusion in the development of cardiac contusion secondary to nonpenetrating chest trauma.Myocardial contusion secondary to nonpenetrating chest trauma can occur in the absence of any identifiable large vessel coronary artery occlusion or injury. It has also been reported in association with coronary artery atheromata, thrombosis, rupture, and fistula formation. After reviewing the clinical and experimental research literature, we conclude that myocardial contusion necrosis results from changes in perfusion of small vessels and the coronary microvasculature. Coronary arteriography and emergency coronary artery bypass surgery do not appear promising as therapeutic modalities to reduce myocardial necrosis in this condition. More appropriate therapeutic emphasis may result from research efforts to develop pharmacologic interventions to preserve contused myocardium similar to those currently being evaluated in the management of patients with ischemic myocardium secondary to coronary artery disease.- - - - - - - - - - ranking = 0.25keywords = vessel (Clic here for more details about this article) |
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