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Deep A, Chan C, Adamson PD, Troughton R, Woodcock E. Isolated Traumatic Membranous Interventricular Septal Rupture: A Rare Complication Following a Motor Vehicle Accident. CASE (PHILADELPHIA, PA.) 2024; 8:303-307. [PMID: 38765627 PMCID: PMC11096650 DOI: 10.1016/j.case.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
•Isolated VSRs are rare after blunt force trauma. •Traumatic VSRs more commonly occur within the apex. •Early diagnosis with echocardiography is imperative for optimal management of VSRs. •Treatment for VSRs involves percutaneous or surgical closure depending on the size.
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Affiliation(s)
- Aashna Deep
- Department of Cardiology, Christchurch Hospital, Christchurch, Canterbury, New Zealand
| | - Christina Chan
- Department of Cardiology, Christchurch Hospital, Christchurch, Canterbury, New Zealand
| | - Philip D. Adamson
- Department of Cardiology, Christchurch Hospital, Christchurch, Canterbury, New Zealand
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
- Christchurch Heart Institute, University of Otago Christchurch, Christchurch, Canterbury, New Zealand
| | - Richard Troughton
- Department of Cardiology, Christchurch Hospital, Christchurch, Canterbury, New Zealand
- Christchurch Heart Institute, University of Otago Christchurch, Christchurch, Canterbury, New Zealand
| | - Ellen Woodcock
- Department of Cardiology, Christchurch Hospital, Christchurch, Canterbury, New Zealand
- Christchurch Heart Institute, University of Otago Christchurch, Christchurch, Canterbury, New Zealand
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2
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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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Emigh B, Grigorian A, Dilday J, Condon F, Nahmias J, Schellenberg M, Martin M, Matsushima K, Inaba K. Risk factors and outcomes in pediatric blunt cardiac injuries. Pediatr Surg Int 2023; 39:195. [PMID: 37160488 DOI: 10.1007/s00383-023-05478-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE Unlike adults, less is known of the etiology and risk factors for blunt cardiac injury (BCI) in children. Identifying risk factors for BCI in pediatric patients will allow for more specific screening practices following blunt trauma. METHODS A retrospective review was performed using the Trauma Quality Improvement Program (TQIP) database from 2017 to 2019. All patients ≤ 16 years injured following blunt trauma were included. Demographics, mechanism, associated injuries, injury severity, and outcomes were collected. Univariate and multivariate regression was used to determine specific risk factors for BCI. RESULTS Of 266,045 pediatric patients included in the analysis, the incidence of BCI was less than 0.2%. The all-cause mortality seen in patients with BCI was 26%. Motor-vehicle collisions (MVCs) were the most common mechanism, although no association with seatbelt use was seen in adolescents (p = 0.158). The strongest independent risk factors for BCI were pulmonary contusions (OR 15.4, p < 0.001) and hemothorax (OR 8.9, p < 0.001). CONCLUSIONS Following trauma, the presence of pulmonary contusions or hemothorax should trigger additional screening investigations specific for BCI in pediatric patients.
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Affiliation(s)
- Brent Emigh
- Division of Trauma and Critical Care, Department of Surgery, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA.
- Department of Surgery, Rhode Island Hospital, 593 Eddy Street, APC 454, Providence, RI, 02903, USA.
| | - Areg Grigorian
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Joshua Dilday
- Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC, University of Southern California, Los Angeles, CA, USA
| | - Freeman Condon
- Division of General Surgery, Department of Surgery, Tripler Army Medical Center, Honolulu, HI, USA
| | - Jeffry Nahmias
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Morgan Schellenberg
- Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC, University of Southern California, Los Angeles, CA, USA
| | - Matthew Martin
- Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC, University of Southern California, Los Angeles, CA, USA
| | - Kazuhide Matsushima
- Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC, University of Southern California, Los Angeles, CA, USA
| | - Kenji Inaba
- Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC, University of Southern California, Los Angeles, CA, USA
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Gupta B, Singh Y, Bagaria D, Nagarajappa A. Comprehensive Management of the Patient With Traumatic Cardiac Injury. Anesth Analg 2023; 136:877-893. [PMID: 37058724 DOI: 10.1213/ane.0000000000006380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
Cardiac injuries are rare but potentially life-threatening, with a significant proportion of victims dying before arrival at the hospital. The in-hospital mortality among patients who arrive in-hospital alive also remains significantly high, despite major advancements in trauma care including the continuous updating of the Advanced Trauma Life Support (ATLS) program. Stab and gunshot wounds due to assault or self-inflicted injuries are the common causes of penetrating cardiac injuries, while motor vehicular accidents and fall from height are attributable causes of blunt cardiac injury. Rapid transport of victim to trauma care facility, prompt recognition of cardiac trauma by clinical evaluation and focused assessment with sonography for trauma (FAST) examination, quick decision-making to perform emergency department thoracotomy, and/or shifting the patient expeditiously to the operating room for operative intervention with ongoing resuscitation are the key components for a successful outcome in cardiac injury victims with cardiac tamponade or exsanguinating hemorrhage. Blunt cardiac injury with arrhythmias, myocardial dysfunction, or cardiac failure may need continuous cardiac monitoring or anesthetic care for operative procedure of other associated injuries. This mandates a multidisciplinary approach working in concert with agreed local protocols and shared goals. An anesthesiologist has a pivotal role to play as a team leader or member in the trauma pathway of severely injured patients. They are not only involved in in-hospital care as a perioperative physician but also participate in the organizational aspects of prehospital trauma systems and training of prehospital care providers/paramedics. There is sparse literature available on the anesthetic management of cardiac injury (penetrating as well as blunt) patients. This narrative review discusses the comprehensive management of cardiac injury patients, focusing on the anesthetic concerns and is guided by our experience in managing cardiac injury cases at Jai Prakash Narayan Apex Trauma Center (JPNATC), All India Institute of Medical Sciences, New Delhi. JPNATC is the only level 1 trauma center in north India, providing services to a population of approximately 30 million with around 9000 operations being performed annually.
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Affiliation(s)
- Babita Gupta
- From the Department of Anaesthesiology, Pain Medicine and Critical Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Yudhyavir Singh
- From the Department of Anaesthesiology, Pain Medicine and Critical Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Dinesh Bagaria
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Abhishek Nagarajappa
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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5
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Woman With Chest Pain. Ann Emerg Med 2023; 81:e39-e40. [PMID: 36813446 DOI: 10.1016/j.annemergmed.2022.08.459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/15/2022] [Accepted: 08/29/2022] [Indexed: 02/22/2023]
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6
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Karan A, Chekka P, Musa T, Esmail K. Graves' Disease-Associated Dilated Cardiomyopathy Unmasked by Blunt Chest Trauma. Cureus 2023; 15:e35488. [PMID: 36999098 PMCID: PMC10046486 DOI: 10.7759/cureus.35488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 02/26/2023] [Indexed: 02/27/2023] Open
Abstract
Graves' disease can manifest with numerous cardiovascular complications, although very few cases result in cardiomyopathy. Our patient presented following a motor vehicle accident where she suffered blunt chest trauma. Her initial presentation was concerning for acute heart failure due to blunt cardiac injury, with diffuse pulmonary edema, hemodynamic instability, and an acutely reduced ejection fraction with global hypokinesis on transthoracic echocardiography. On further evaluation with thyroid function testing and autoimmune studies, she was found to have uncontrolled Graves' disease. She was subsequently started on methimazole for her Graves' cardiomyopathy. Following discharge, an outpatient cardiac MRI revealed no late gadolinium enhancement and complete recovery of her ejection fraction to normal values. This case serves to highlight the importance of a complete evaluation of cardiomyopathy and highlights an interesting case of a patient with blunt chest injury with a background of undetected Graves' cardiomyopathy.
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7
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Bae CM, Cho JY, Jung H, Son SA. Serum pro-B-type natriuretic peptide levels and cardiac index as adjunctive tools of blunt cardiac injury. BMC Cardiovasc Disord 2023; 23:81. [PMID: 36765285 PMCID: PMC9912581 DOI: 10.1186/s12872-022-02990-2] [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] [Received: 03/07/2022] [Accepted: 12/02/2022] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Blunt cardiac injury (BCI) has a variety of symptoms that may be a potentially life-threatening injury that can lead to death. Depending on the diagnosis of BCI, treatment direction and length of stay may vary. In addition, the utility of other diagnostic tests for cardiac disease as diagnostic tools for BCI remain unclear. The purpose of this study was to investigate the competence of N-terminal pro-B-type natriuretic peptide (NT pro-BNP) and cardiac index (C.I) as adjunctive diagnostic tools for BCI. METHODS From January 2018 to March 2020, severe trauma patients with sternum fracture who were admitted to the traumatic intensive care unit (TICU) were included this study. Patients with sternum fracture, 18 years of age or older, and with an injury severity score > 16 who required intensive care were included. Invasive measurement for the analysis of the pulse contour for C.I monitoring and intravenous blood sampling for NT pro-BNP measurement were performed. Sampling and 12-lead electrocardiogram were performed at different time points as follows: immediately after TICU admission and at 24 h and 48 h after trauma. RESULTS Among 103; 33 patients with factors that could affect NT pro-BNP were excluded; therefore, 63 patients were included in this study. According to the American Association for the Surgery of Trauma Cardiac Injury Scale, 33 patients were diagnosed with non-BCI, and 30 patients constituted with BCI. The median ages of the patients were 58 (52-69), and 60 (45-69) years in the non-BCI and BCI groups, respectively (p = 0.77). The median NT pro-BNP values were higher in the BCI group on admission, hospital day (HD) 2, and HD 3, however, no statistical difference was observed (125 (49-245) vs. 130 (47-428) pg/mL, p = 0.08, 124 (68-224) vs. 187 (55-519) pg/mL, p = 0.09, and 121(59-225) vs. 133 (56-600) pg/mL, p = 0.17, respectively). On the contrary, significantly lower values were observed in the median C.I measurement on admission and HD 3 in the BCI group (3.2 (2.8-3.5) vs. 2.6 (2.3-3.5) L/min/m2, p < 0.01 and 3.2 (3.1-3.9) vs. 2.9 (2.4-3.2) L/min/m2, p < 0.01, respectively); however, no significant difference was observed on HD 2 (3.4 (3.0-3.7) vs. 2.6 (2.4-3.4) L/min/m2, p = 0.17), Furthermore, The median lactate levels in the BCI group upon admission, HD 2, and HD 3 were significantly higher than those in the non-BCI group (1.8 (1.1-2.6) vs. 3.1 (2.1-4.4) mmol/L, p < 0.01; 1.3 (0.8-2.3) vs. 3.0 (2.2-4.7) mmol/L, p < 0.01; and 1.5 (0.9-1.5) vs. 2.2 (1.3-3.7) mmol/L, p < 0.01, respectively). CONCLUSION Consecutive values of NT pro-BNP and C.I show no correlation with ECG-based BCI diagnosis. However, lactate level measurement may help in the early recognition of BCI as an adjunctive tool. It should be noted that this is a hypothesis-generating study for BCI diagnosis. Further studies should be conducted in larger populations with a prospective approach.
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Affiliation(s)
- Chae-Min Bae
- grid.411235.00000 0004 0647 192XDepartment of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, Republic of Korea
| | - Joon Yong Cho
- grid.411235.00000 0004 0647 192XDepartment of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, Republic of Korea
| | - Hanna Jung
- grid.411235.00000 0004 0647 192XDepartment of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, Republic of Korea
| | - Shin-Ah Son
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, Republic of Korea.
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8
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Nair L, Winkle B, Senanayake E. Managing blunt cardiac injury. J Cardiothorac Surg 2023; 18:71. [PMID: 36765392 PMCID: PMC9912488 DOI: 10.1186/s13019-023-02146-z] [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: 02/13/2022] [Accepted: 01/09/2023] [Indexed: 02/12/2023] Open
Abstract
Blunt cardiac injury (BCI) encompasses a spectrum of pathologies ranging from clinically silent, transient arrhythmias to deadly cardiac wall rupture. Of diagnosed BCIs, cardiac contusion is most common. Suggestive symptoms may be unrelated to BCI, while some injuries may be clinically asymptomatic. Cardiac rupture is the most devastating complication of BCI. Most patients who sustain rupture of a heart chamber do not reach the emergency department alive. The incidence of BCI following blunt thoracic trauma remains variable and no gold standard exists to either diagnose cardiac injury or provide management. Diagnostic tests should be limited to identifying those patients who are at risk of developing cardiac complications as a result of cardiac in jury. Therapeutic interventions should be directed to treat the complications of cardiac injury. Prompt, appropriate and well-orchestrated surgical treatment is invaluable in the management of the unstable patients.
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Affiliation(s)
- Lawrence Nair
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD, 4032, Australia.
| | - Brendan Winkle
- Department of Surgery, Royal Darwin Hospital, Darwin, NT, Australia
| | - Eshan Senanayake
- Department of Cardiothoracic Surgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
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9
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Patton JW, Burton BN, Milam AJ, Mariano ER, Gabriel RA. Health disparities in regional anesthesia and analgesia for the management of acute pain in trauma patients. Int Anesthesiol Clin 2023; 61:8-15. [PMID: 36398629 DOI: 10.1097/aia.0000000000000382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- John W Patton
- Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, Los Angeles, California
| | - Brittany N Burton
- Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, Los Angeles, California
| | - Adam J Milam
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona
| | - Edward R Mariano
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
- Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California
| | - Rodney A Gabriel
- Divisions of Regional Anesthesia and Perioperative Informatics, Department of Anesthesiology, University of California San Diego, San Diego, California
- Department of Biomedical Informatics, University of California San Diego, San Diego, California
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10
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Tang CC, Huang JF, Kuo LW, Cheng CT, Liao CH, Hsieh CH, Fu CY. The highest troponin I level during admission is associated with mortality in blunt cardiac injury patients. Injury 2022; 53:2960-2966. [PMID: 35750532 DOI: 10.1016/j.injury.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 05/28/2022] [Accepted: 06/08/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cardiac troponin I (cTnI) levels are usually measured in primary evaluations of blunt cardiac injury (BCI) patients. We evaluated the associations of cTnI levels with the outcomes of BCI patients at different times. METHODS From 2015 to 2019, blunt chest trauma patients with elevated cTnI levels were compared with patients without elevated cTnI levels using propensity score matching (PSM) to minimize selection bias. The cTnI levels at different times in the survivors and nonsurvivors were compared. RESULTS A total of 2,287 blunt chest trauma patients were included, and 57 (2.5%) of the patients had BCIs. PSM showed that patients with and without elevated cTnI levels had similar mortality rates (13.0% vs. 11.1%, p-value = 0.317], hospital lengths of stay (LOSs) [17.3 (14.4) vs. 15.5 (22.2) days, p-value = 0.699] and intensive care unit (ICU) LOSs [7.7 (12.1) vs. 6.4 (15.4) days, p-value = 0.072]. Among the BCI patients, nonsurvivors had a significantly higher highest cTnI level during the observation period than survivors. Additionally, patients who needed surgical intervention had significantly higher highest cTnI levels than patients who did not. CONCLUSIONS An elevated cTnI level is insufficient for the evaluation of BCI and the determination of the need for further treatment. The highest cTnI level during the observation period may be related to mortality and the need for surgery in BCI patients.
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Affiliation(s)
- Chia-Chun Tang
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Jen-Fu Huang
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Ling-Wei Kuo
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Chi-Tung Cheng
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Chien-Hung Liao
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Chi-Hsun Hsieh
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Chih-Yuan Fu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.
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11
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Higgins MC, Shi J, Bader M, Kohanteb PA, Brahmbhatt TS. Role of Interventional Radiology in the Management of Non-aortic Thoracic Trauma. Semin Intervent Radiol 2022; 39:312-328. [PMID: 36062226 PMCID: PMC9433159 DOI: 10.1055/s-0042-1753482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Trauma remains a leading cause of death for all age groups, and nearly two-thirds of these individuals suffer thoracic trauma. Due to the various types of injuries, including vascular and nonvascular, interventional radiology plays a major role in the acute and chronic management of the thoracic trauma patient. Interventional radiologists are critical members in the multidisciplinary team focusing on treatment of the patient with thoracic injury. Through case presentations, this article will review the role of interventional radiology in the management of trauma patients suffering thoracic injuries.
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Affiliation(s)
- Mikhail C.S.S. Higgins
- Department of Radiology, Boston Medical Center, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Jessica Shi
- Boston University School of Medicine, Boston, Massachusetts
| | - Mohammad Bader
- Department of Radiology, Boston Medical Center, Boston, Massachusetts
| | - Paul A. Kohanteb
- Department of Radiology, Boston Medical Center, Boston, Massachusetts
| | - Tejal S. Brahmbhatt
- Boston University School of Medicine, Boston, Massachusetts
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care; Boston Medical Center, Boston, Massachusetts
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12
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Blunt thoracic trauma: role of chest radiography and comparison with CT - findings and literature review. Emerg Radiol 2022; 29:743-755. [PMID: 35595942 DOI: 10.1007/s10140-022-02061-1] [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: 03/18/2022] [Accepted: 05/12/2022] [Indexed: 10/18/2022]
Abstract
In the setting of acute trauma where identification of critical injuries is time-sensitive, a portable chest radiograph is broadly accepted as an initial diagnostic test for identifying benign and life-threatening pathologies and guiding further imaging and interventions. This article describes chest radiographic findings associated with various injuries resulting from blunt chest trauma and compares the efficacy of the chest radiograph in these settings with computed tomography (CT). Common chest radiographic findings in blunt thoracic injuries will be reviewed to improve radiologic identification, expedite management, and improve trauma morbidity and mortality. This article discusses demographic information, mechanism of specific injuries, common imaging findings, imaging pearls, and pitfalls and exhibits several classic imaging findings in blunt chest trauma. Thoracic structures commonly injured in blunt trauma that will be discussed in this article include vasculature structures (aortic trauma), the heart (cardiac contusion, pericardial effusion), the esophagus (esophageal perforation), pleural space and airways (pneumothorax, hemothorax, bronchial injury), lungs (pulmonary contusion), the diaphragm (diaphragmatic rupture), and the chest wall (flail chest). Chest radiography plays an important role in the initial evaluation of blunt chest trauma. While CT imaging has a higher sensitivity than chest radiography, it remains a valuable tool due to its ability to provide rapid diagnostic information in time-sensitive trauma situations and is ubiquitously available in the trauma bay. Familiarity with the gamut of injuries that may occur as well as identification of the associated chest radiograph findings can aid in timely diagnoses and prompt management in the setting of acute blunt chest trauma.
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13
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Latif RK, Clifford SP, Ghafghazi S, Phipps Z, Chen JJ, Sangroula D, Khan AZ, Saleem J, Farah I, Huang J, Businger JR. Echocardiography and Management for Cardiac Trauma. J Cardiothorac Vasc Anesth 2022; 36:3265-3277. [DOI: 10.1053/j.jvca.2022.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/19/2022] [Accepted: 02/08/2022] [Indexed: 12/14/2022]
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14
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Ishay SY, Raichel L, Tabo LY, Semyonov M, Barsky G, Acker A, Shaked G, Sahar G. Penetrating pulmonary vein laceration following blunt chest trauma. Trauma Case Rep 2022; 37:100596. [PMID: 35005170 PMCID: PMC8717223 DOI: 10.1016/j.tcr.2021.100596] [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: 12/18/2021] [Indexed: 11/12/2022] Open
Abstract
Flail chest is a common injury in blunt trauma which is usually treated with analgesia, oxygen, and other conservative measures. In more severe cases mechanical ventilation and surgical stabilization of rib fractures (SSRF) may be warranted. Penetrating injury to the heart or great vessels due to rib fractures however, is much less common. Here we present a 33 year old male that was admitted to the Emergency department (ED) after a horse riding accident, demonstrating severe shock. Emergency computerized tomography scan showed multiple bilateral displaced rib fractures, Left hemothorax and possibly a penetrating injury to the left side of the heart by one of the ribs. Notably, no significant pericardial effusion was demonstrated. In addition, a grade V splenic injury was diagnosed. A Joined thoracic and abdominal emergent surgical treatment was successfully carried out and the patient survived and fully recovered.
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Affiliation(s)
- Shlomo Y Ishay
- Department of cardiothoracic surgery, Soroka University Medical Center, Israel
| | - Lior Raichel
- Department of cardiothoracic surgery, Soroka University Medical Center, Israel
| | - Limor Y Tabo
- Department of cardiothoracic surgery, Soroka University Medical Center, Israel
| | - Michael Semyonov
- Department of anesthesia, Soroka University Medical Center, Israel
| | - Guy Barsky
- Department of general surgery, Soroka University Medical Center, Israel
| | - Asaf Acker
- Department of Orthopedic Surgery, Soroka University Medical Center, Israel
| | - Gad Shaked
- Department of general surgery, Soroka University Medical Center, Israel
| | - Gideon Sahar
- Department of cardiothoracic surgery, Soroka University Medical Center, Israel
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15
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Park A, Principe DR. OUP accepted manuscript. J Surg Case Rep 2022; 2022:rjac008. [PMID: 35169437 PMCID: PMC8840872 DOI: 10.1093/jscr/rjac008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/04/2022] [Indexed: 11/18/2022] Open
Abstract
The presentation of blunt cardiac injuries (BCIs) following thoracic trauma is extremely varied, classically affecting the right-sided chambers of the heart. In extremely rare cases, BCIs can affect the coronary arteries. Diagnosing a traumatic coronary dissection can be challenging, as not only is presentation highly variable, but dissections are often masked by concomitant injuries. Here, we present the unusual case of a patient presenting to the emergency department following blunt thoracic trauma from an automobile accident. He demonstrated diffuse S and T wave segment elevations on electrocardiogram, and coronary angiography was significant for occlusion of the apical left anterior descending artery and stenosis of the second obtuse marginal artery. The patient was diagnosed with a BCI causing a left-sided coronary artery dissection. This serves as an important reminder that BCIs can manifest in any part of the cardiac anatomy, and should be considered in any patient with a history of thoracic trauma.
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Affiliation(s)
- Alex Park
- Correspondence address. Department of Surgery, MC 958 840 South Wood Street, Suite 376-CSN, University of Illinois College of Medicine, Chicago, IL 60612, USA. Tel: (331) 575-9007; E-mail:
| | - Daniel R Principe
- Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
- Medical Scientist Training Program, University of Illinois College of Medicine, Chicago, IL, USA
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16
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Lee SH, Jang MJ, Jeon YB. Blunt Cardiac Injuries That Require Operative Management: A Single-Center 7-Year Experience. JOURNAL OF TRAUMA AND INJURY 2021. [DOI: 10.20408/jti.2020.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose Blunt cardiac injuries (BCI) have a wide clinical spectrum, ranging from asymptomatic myocardial contusion to cardiac rupture and death. BCIs rarely require surgical intervention, but can be rapidly fatal, requiring prompt evaluation and surgical treatment in some cases. The aim of this study was to identify potential factors associated with in-hospital mortality after surgery in patients with BCI. Methods The medical records of 15 patients who had undergone emergency cardiac surgery for BCI between January 2014 and August 2020 were retrospectively reviewed. We included trauma patients older than 18 years admitted to Regional Trauma Center, Gachon University Gil Medical Center during the study period. Clinical and laboratory variables were compared between survivors and non-survivors. Results Non-survivors showed a significantly higher Injury Severity Score (p=0.001) and Abbreviated Injury Scale in the chest region (p=0.001) than survivors. American Association for the Surgery of Trauma-Organ Injury Scale Grade V injuries were significantly more common in non-survivors than in survivors (p=0.031). Non-survivors had significantly more preoperative packed red blood cell (PRBC) transfusions (p=0.019) and were significantly more likely to experience preoperative cardiac arrest (p=0.001) than survivors. Initial pH (p=0.010), lactate (p=0.026), and base excess (BE; p=0.026) levels showed significant differences between the two groups. Conclusions Initial pH, lactate, BE, ventricular injury, the amount of preoperative PRBC transfusions, and preoperative cardiac arrest were potential predictors of in-hospital mortality.
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17
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Patel KM, Kumar NS, Desai RG, Mitrev L, Trivedi K, Krishnan S. Blunt Trauma to the Heart: A Review of Pathophysiology and Current Management. J Cardiothorac Vasc Anesth 2021; 36:2707-2718. [PMID: 34840072 DOI: 10.1053/j.jvca.2021.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/09/2021] [Accepted: 10/13/2021] [Indexed: 11/11/2022]
Abstract
Blunt cardiac injury (BCI), defined as an injury to the heart from blunt force trauma, ranges from minor to life-threatening. The majority of BCIs are due to motor vehicle accidents; however, injuries caused by falls, blasts, and sports-related injuries also can be sources of BCI. A significant proportion of patients with BCI do not survive long enough to receive medical care, succumbing to their injuries at the scene of the accident. Additionally, patients with blunt trauma often have coexisting injuries (brain, spine, orthopedic) that can obscure the clinical picture; therefore, a high degree of suspicion often is required to diagnose BCI. Traditionally, hemodynamically stable injuries suspicious for BCI have been evaluated with electrocardiograms and chest radiographs, whereas hemodynamically unstable BCIs have received operative intervention. More recently, computed tomography and echocardiography increasingly have been utilized to identify injuries more rapidly in hemodynamically unstable patients. Transesophageal echocardiography can play an important role in the diagnosis and management of several BCIs that require operative repair. Close communication with the surgical team and access to blood products for potentially massive transfusion also play key roles in maintaining hemodynamic stability. With proper surgical and anesthetic care, survival in cases involving urgent cardiac repair can reach 66%-to-75%. This narrative review focuses on the types of cardiac injuries that are caused by blunt chest trauma, the modalities and techniques currently used to diagnose BCI, and the perioperative management of injuries that require surgical correction.
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Affiliation(s)
- Kinjal M Patel
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ.
| | - Nakul S Kumar
- Cardiothoracic and Critical Care Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH
| | - Ronak G Desai
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ
| | - Ludmil Mitrev
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ
| | - Keyur Trivedi
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ
| | - Sandeep Krishnan
- Adult Cardiothoracic Anesthesiology, Wayne State University School of Medicine Pontiac, MI
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Right Coronary Artery STEMI following Blunt Thoracic Trauma. Case Rep Cardiol 2021; 2021:5598524. [PMID: 34447594 PMCID: PMC8384542 DOI: 10.1155/2021/5598524] [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: 01/31/2021] [Accepted: 07/17/2021] [Indexed: 12/01/2022] Open
Abstract
We present a case report of an otherwise healthy 37-year-old male without pertinent cardiac history or risk factors, who presented with cardiac trauma after a motor vehicle collision (MVC). Initial workup including electrocardiogram (ECG), transthoracic echocardiogram (TTE), and uptrending serial troponins warranted coronary angiography, during which occlusive thrombi were discovered in the proximal right coronary artery (pRCA), the right posterolateral vessel (rPL), and the right posterior descending artery (PDA). Subsequently, the patient underwent percutaneous coronary intervention of the RCA and PDA with aspiration thrombectomy. He was then initiated on dual antiplatelet therapy (DAPT) and recovered appropriately. This case is presented with the goal of enlightening the academic community of a rare complication while presenting a judicious approach to management in an attempt to decrease the occurrence of “near misses” in the future.
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Handlos P, Klabal O, Uvíra M. Regarding "Isolated Right Atrial Rupture From Blunt Chest Trauma in Motor Vehicle Collisions: Mechanisms of Injury and Outcomes". Am J Forensic Med Pathol 2021; 42:101-102. [PMID: 33074841 DOI: 10.1097/paf.0000000000000631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Early myocardial damage (EMD) and valvular insufficiency result in impaired cardiac function after multiple trauma in pigs. Sci Rep 2021; 11:1151. [PMID: 33441945 PMCID: PMC7806767 DOI: 10.1038/s41598-020-80409-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 10/20/2020] [Indexed: 12/14/2022] Open
Abstract
One third of multiple trauma patients present abnormal echocardiographic (ECHO) findings. Therefore, ECHO diagnostic after trauma is indicated in case of hemodynamic instability, shock, after chest trauma and after cardiac arrest. 20 male pigs underwent multiple trauma. Blood samples were collected 4 and 6 h after trauma and concentrations of heart-type fatty acid binding protein (HFABP) as a biomarker for EMD were measured. Myocardial damage was evaluated by scoring Hematoxylin–Eosin stained sections. At baseline, 3 and 6 h after trauma, transesophageal ECHO (TOE) was performed, invasive arterial and left ventricular blood pressure were measured to evaluate the cardiac function after multiple trauma. Systemic HFABP concentrations were elevated, furthermore heart injury score in multiple trauma animals was increased determining EMD. A significant decrease of blood pressure in combination with a consecutive rise of heart frequency was observed. Ongoing depression of mean arterial pressure and diastolic blood pressure were accompanied by changes in ECHO-parameters indicating diastolic and systolic dysfunction. Furthermore, a valvular dysfunction was detected. In this study complex myocardial and valvular impairment after multiple trauma in pigs has been observed. Therefore, detection of EMD and progressive valvular dysfunction might be crucial and therapeutically relevant.
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21
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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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Long B, Long DA, Tannenbaum L, Koyfman A. An emergency medicine approach to troponin elevation due to causes other than occlusion myocardial infarction. Am J Emerg Med 2020; 38:998-1006. [DOI: 10.1016/j.ajem.2019.12.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 11/18/2019] [Accepted: 12/04/2019] [Indexed: 02/06/2023] Open
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Fernando RJ, Anderson BY, Augoustides JG, Zhou E, Radvansky B, Marchant BE, Morris BE, Weiss SJ, Patel PA. Traumatic Rupture of the Left Atrial Appendage: Perioperative Management and Echocardiographic Challenges. J Cardiothorac Vasc Anesth 2020; 34:1074-1081. [DOI: 10.1053/j.jvca.2019.12.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 12/30/2019] [Indexed: 12/25/2022]
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Haywood ST, Patel K, Gallo D, Silver K, Jouriles N. Throws of Death: Traumatic Coronary Artery Dissection Resulting From Jiu Jitsu Training. J Emerg Med 2020; 58:63-66. [PMID: 31744712 DOI: 10.1016/j.jemermed.2019.09.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 08/23/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The risk of cardiac injury in blunt thoracic trauma is quite rare, occurring in only 0.1% of patients. The least common cardiac injury is coronary artery dissection. Most cardiac injuries result from high-energy mechanisms such as motor vehicle collisions. Even low-mechanism injuries that have been reported involved rapid deceleration. CASE REPORT We present a case of traumatic coronary artery dissection that resulted from a low-energy blunt thoracic injury with no rapid deceleration. This patient had no other associated thoracic injuries, such as rib fractures or sternal fracture. Following presentation, our patient twice deteriorated into ventricular fibrillation and was successfully resuscitated each time. The coronary lesion was successfully stented and the patient was eventually discharged home. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case underscores the importance of maintaining a high level of suspicion for coronary artery dissection even in low-energy mechanisms. An electrocardiogram should be obtained early, even in low-energy mechanisms. While patients with traumatic cardiac injuries will commonly present with other injuries, such as rib fractures, the absence of these injuries does not rule out cardiac injury.
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25
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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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26
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Merlo A, Ikonomidis J, Caranasos T, Kolarczyk L. Tricuspid Valve Avulsion After Blunt Chest Wall Trauma: A Case Report for Urgent Valve Replacement. A A Pract 2019; 13:233-235. [PMID: 31206384 DOI: 10.1213/xaa.0000000000001042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Tricuspid valve (TV) avulsion is rare and ordinarily does not require emergent intervention. We present the case of a polytrauma patient with traumatic TV avulsion who ultimately required urgent TV replacement in the setting of hemodynamic instability. Urgent TV replacement may be warranted after careful consideration of patient risk factors and clinical context.
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Affiliation(s)
- Aurelie Merlo
- From the Division of Cardiothoracic Surgery, Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - John Ikonomidis
- From the Division of Cardiothoracic Surgery, Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Thomas Caranasos
- From the Division of Cardiothoracic Surgery, Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Lavinia Kolarczyk
- Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina
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27
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Siado SA, Martínez-Montalvo CM, Osorio M, Gómez A, Jiménez HC. Utilidad de las pruebas diagnósticas en el trauma cardiaco cerrado. REVISTA COLOMBIANA DE CIRUGÍA 2019. [DOI: 10.30944/20117582.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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28
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Barbero C, Ricci D, Boffini M, Rinaldi M. Traumatic heart and great vessels injuries. J Thorac Dis 2019; 11:S192-S195. [PMID: 30906585 DOI: 10.21037/jtd.2018.10.73] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Cristina Barbero
- Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza, San Giovanni Battista Hospital "Molinette", Turin, Italy
| | - Davide Ricci
- Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza, San Giovanni Battista Hospital "Molinette", Turin, Italy
| | - Massimo Boffini
- Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza, San Giovanni Battista Hospital "Molinette", Turin, Italy
| | - Mauro Rinaldi
- Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza, San Giovanni Battista Hospital "Molinette", Turin, Italy
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30
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Muramatsu H, Umino K, Masuda H, Ishizawa F, Sugano Y, Honda K. Severe Cardiac Rupture by Only One Blow to the Chest in a Young Boy: An Autopsy Case. J Forensic Sci 2018; 64:1238-1240. [PMID: 30462838 DOI: 10.1111/1556-4029.13965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 10/31/2018] [Accepted: 11/05/2018] [Indexed: 11/29/2022]
Abstract
Cardiac rupture by blunt chest trauma is commonly seen after motor vehicle accidents and falls; however, it is rarely caused by a blow to the chest. We herein report an autopsy case of a high school boy who sustained severe right ventricular rupture by only one knee kick to the chest during a quarrel. He was hospitalized and developed cardiopulmonary arrest. Emergency surgery was performed, but the patient died. The autopsy revealed no external severe trauma or deformation, but the side wall of the right ventricle contained a large V-shaped laceration. The other thoracic organs had no injuries. This case illustrates that severe cardiac rupture can occur by only one blow to the chest. Blunt cardiac injuries can occur even if no severe injuries are present on the body surface. We should consider the possibility of severe cardiac injuries regardless of the presence of external injuries.
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Affiliation(s)
- Hisanori Muramatsu
- Department of Legal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Keishi Umino
- Department of Legal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hiroko Masuda
- Department of Legal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Fujio Ishizawa
- Department of Legal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yukiko Sugano
- Department of Legal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Katsuya Honda
- Department of Legal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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32
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Rupprecht H, Gaab K. Delayed Cardiac Rupture Induced by Traumatic Myocardial Infarction: Consequence of a 45-Magnum Blast Injury; A Comprehensive Case Review. Bull Emerg Trauma 2018; 6:1-7. [PMID: 29379803 DOI: 10.29252/beat-060101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
A penetrating chest trauma, a myocardial contusion or a myocardial infarction can lead to a cardiac rupture, which is linked to an extreme high death rate. Only few cases with delayed perforation of the myocardium have been reported in literature. We report about a penetrating gunshot injury, which led to a myocardial contusion with secondary delayed rupture of the left ventricle and the left inferior lobe of the lung. The leakage of the lesion in the left ventricle could be sealed sufficiently with fibrin-coated collagen fleeces after adapting stitches with Prolene 2-0. For additional stabilization of the vulnerable myocardium area, a bovine patch has been placed on the damaged ventricle. Fibrin fleeces are used successfully in cardiac surgery, as in our case, to seal the leakage of the lesion in the left ventricle. The implantation of a bovine patch in the pericardium could prevent a cardiac compartment syndrome with a fatal pericardial tamponade. To prohibit a thoracic compartment syndrome a modified Bogota bag could be sewed in for temporarily closure of the chest. In most cases penetrating cardiac injuries can be treated without heart-lung-machines. An immediate transfer to a cardio-surgical center is, due to the acute situation, not possible. If a surgeon with thoraco-surgical expertise is present a transfer is not absolutely necessary.
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Affiliation(s)
- Holger Rupprecht
- Department of General and Visceral Surgery and Thoracic, Clinical Center Fuerth, Fuerth, Bavaria, Germany 90766
| | - Katharina Gaab
- Department of General and Visceral Surgery and Thoracic, Clinical Center Fuerth, Fuerth, Bavaria, Germany 90766
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33
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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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34
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Abstract
Thoracic injury is common in high-energy and low-energy trauma, and is associated with significant morbidity and mortality. Evaluation requires a systematic approach prioritizing airway, respiration, and circulation. Chest injuries have the potential to progress rapidly and require prompt procedural intervention. For the diagnosis of nonemergent injuries, a careful secondary survey is essential. Although medicine and trauma management have evolved throughout the decades, the basics of thoracic trauma care have remained the same.
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Affiliation(s)
- Joseph J Platz
- University of Vermont Medical Center, 111 Colchester Avenue, Burlington, VT 05401, USA.
| | - Loic Fabricant
- University of Vermont Medical Center, 111 Colchester Avenue, Burlington, VT 05401, USA
| | - Mitch Norotsky
- University of Vermont Medical Center, 111 Colchester Avenue, Burlington, VT 05401, USA
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35
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Singh A, Collins B, Qamar A, Gupta A, Fatima A, Divakaran S, Klein J, Hainer J, Jarolim P, Shah RV, Nasir K, Di Carli MF, Bhatt DL, Blankstein R. Study of young patients with myocardial infarction: Design and rationale of the YOUNG-MI Registry. Clin Cardiol 2017; 40:955-961. [PMID: 28805969 DOI: 10.1002/clc.22774] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 07/17/2017] [Indexed: 11/06/2022] Open
Abstract
The YOUNG-MI registry is a retrospective study examining a cohort of young adults age ≤ 50 years with a first-time myocardial infarction. The study will use the robust electronic health records of 2 large academic medical centers, as well as detailed chart review of all patients, to generate high-quality longitudinal data regarding the clinical characteristics, management, and outcomes of patients who experience a myocardial infarction at a young age. Our findings will provide important insights regarding prevention, risk stratification, treatment, and outcomes of cardiovascular disease in this understudied population, as well as identify disparities which, if addressed, can lead to further improvement in patient outcomes.
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Affiliation(s)
- Avinainder Singh
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Bradley Collins
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Arman Qamar
- Cardiovascular Division, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ankur Gupta
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Amber Fatima
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sanjay Divakaran
- Cardiovascular Division, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Josh Klein
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jon Hainer
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Petr Jarolim
- Department of Pathology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ravi V Shah
- Cardiovascular Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Khurram Nasir
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, Florida
| | - Marcelo F Di Carli
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Deepak L Bhatt
- Cardiovascular Division, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ron Blankstein
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Abstract
The elderly population is rapidly increasing in number. Therefore, geriatric trauma is becoming more prevalent. All practitioners caring for geriatric trauma patients should be familiar with the structural and functional changes naturally occurring in the aging heart, as well as common preexisting cardiac diseases in the geriatric population. Identification of the shock state related to cardiac dysfunction and targeted assessment of perfusion and resuscitation are important when managing elderly patients. Finally, management of cardiac dysfunction in the trauma patient includes an appreciation of the inherent effects of trauma on cardiac function.
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Abstract
INTRODUCTION Atrioventricular node (AVN) contusion usually results in cardiogenic shock and arrhythmia and is a rare but fatal condition. The condition is difficult to diagnose and easily overlooked because it develops rapidly and is asymptomatic. We here report 3 cases that demonstrate blunt chest impact and hemorrhages of the posterior atrioventricular junction, eventually result in death. CLINICAL FINDINGS Autopsy and histological examination were performed on all cases. External inspection revealed bruises in the hearts and fractures in the sternum and ribs. However, histological examinations were conclusive and showed cardiac contusion on the surface of the posterior atrioventricular junction of the individuals, and the death was due to the AVN contusion. The position of the AVN on the heart surface is determined by detailed examinations via an autopsy and microscopic, both of which are critical in the certification of cause of death. CONCLUSION The report is intended to raise our understanding and make forensic pathologists aware of the surface of the posterior atrioventricular junction.
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Affiliation(s)
- Wenhe Li
- Department of Forensic Medicine, Huazhong University of Science and Technology, Tongji Medical College
- Department of Pathology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Techology, PR China
| | - Lin Zhang
- Department of Forensic Medicine, Huazhong University of Science and Technology, Tongji Medical College
| | - Yue Liang
- Department of Forensic Medicine, Huazhong University of Science and Technology, Tongji Medical College
| | - Fang Tong
- Department of Forensic Medicine, Huazhong University of Science and Technology, Tongji Medical College
| | - Yiwu Zhou
- Department of Forensic Medicine, Huazhong University of Science and Technology, Tongji Medical College
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38
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Lamela Domenech AE, Lopez-Menendez F, López-Candales A. Tricuspid Papillary Muscle Rupture Due to Blunt Chest Trauma. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:2733-2736. [PMID: 27872424 DOI: 10.7863/ultra.15.12058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
| | | | - Angel López-Candales
- Cardiovascular Medicine Division, University of Puerto Rico School of Medicine, Medical Sciences, Campus San Juan, Puerto Rico
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39
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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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40
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Pol MM, Prasad KSK, Deo V, Uniyal M. Penetrating cardiac injury: sustaining health by building team resilience in growing civilian violence. BMJ Case Rep 2016; 2016:bcr-2016-216293. [PMID: 27591038 DOI: 10.1136/bcr-2016-216293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Penetrating cardiac injury (PCI) is gradually increasing in developing countries owing to large-scale manufacturing of illegal country-made weapons. These injuries are associated with significant morbidity and mortality. Logistically it is difficult to have all organ-based specialists arrive together and attend every critically injured patient round-the-clock in developing countries. It is therefore important for doctors (physicians, surgeons and anaesthetists) to be trained for adequate management of critically injured patients following trauma. We report the approach towards 2 cases of haemodynamically unstable PCI managed by a team of trauma doctors. Time lag (duration between injury and arrival at hospital) and quick horizontal resuscitation are important considerations in the treatment. By not referring these patients to different hospitals the team actually reduced the time lag, and a quick life-saving surgery by trauma surgeons (trained in torso surgery) offered these almost dying patients a chance of survival.
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Affiliation(s)
| | - K Shiv Krishna Prasad
- Surgery (Surgical Disciplines) All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Vishant Deo
- Surgery (Surgical Disciplines) All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Madhur Uniyal
- Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
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41
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Jadhav N, Gupta P, Press MC. Right ventricular marginal branch occlusion after blunt force trauma to the chest. TRAUMA-ENGLAND 2016. [DOI: 10.1177/1460408615606751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Coronary artery occlusion following a blunt trauma is a rare complication. We report a case of a 56-year-old man who experienced an intermediate code trauma following a motor vehicle accident. The patient had a visible ‘seat-belt sign’ and complained of chest pain. Initial electrocardiogram showed mild ST segment elevation accompanied by elevation of cardiac enzymes. Echocardiogram and cardiac magnetic resonance imaging were consistent with right ventricular systolic dysfunction. Coronary angiogram revealed 100% occlusion of proximal right ventricular marginal branch. The patient was managed medically. This case presents a rare case of right ventricular marginal occlusion following blunt chest trauma.
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42
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Mahmood I, El-Menyar A, Dabdoob W, Abdulrahman Y, Siddiqui T, Atique S, Arumugam SK, Latifi R, Al-Thani H. Troponin T in Patients with Traumatic Chest Injuries with and without Cardiac Involvement: Insights from an Observational Study. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2016; 8:17-24. [PMID: 27011943 PMCID: PMC4784179 DOI: 10.4103/1947-2714.175188] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Serum troponin T (TnT) is a common marker of myocardial injury. However, its implication in the absence of clinical evidence of cardiac reason is not well established. AIMS The aim of this study was to identify the implications of positive TnT in traumatic chest injury (TCI) patients regardless of the cardiac involvement. MATERIALS AND METHODS We conducted a retrospective analysis of all TCI patients admitted to level 1 trauma center between 2008 and 2011. Patients who underwent TnT testing were divided into two groups: Group 1 (positive TnT) and Group 2 (negative TnT). The two groups were analyzed and compared, and multivariate regression analyses were performed to identify predictors of TnT positivity and mortality. RESULTS Out of 993 blunt TCI patients, 19.3% had positive TnT (Group 1). On comparison to Group 2, patients in Group 1 were 5 years younger and more likely to have head, cardiac, hepatic, splenic, and pelvic injuries, in addition to lung contusion. Positive TnT was associated with higher Injury Severity Score (ISS) (P = 0.001), higher chest Abbreviated Injury Score (AIS) (P = 0.001), and longer hospital stay (P = 0.03). In addition, Group 1 patients were more likely to undergo chest tube insertion, exploratory laparotomy, mechanical ventilation, and tracheostomy. Twenty patients had cardiac involvement, and of them 14 had positive TnT. Among 973 patients who showed no evidence of cardiac involvement, 178 had positive TnT (18.3%). There were 104 deaths (60% in Group 1). On multivariate regression analysis, the predictors of hospital mortality were positive TnT, head injury, and high ISS, whereas, the predictors of TnT positivity were cardiac, hepatic, and pelvic injuries; higher ISS; and age. CONCLUSIONS Positive TnT in blunt TCI patients is a common challenge, particularly in polytrauma cases. Patients with positive TnT tend to have the worst outcome even in the absence of clinical evidence of acute cardiac involvement. Positive TnT is also a reflection of the severity of chest or extrathoracic injuries; however, further prospective studies are warranted.
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Affiliation(s)
- Ismail Mahmood
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar; Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar; Department of Internal Medicine, Cardiology Unit, Ahmed Maher Teaching Hospital, Cairo, Egypt
| | - Wafer Dabdoob
- Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar; Department of Cardiology, Hamad General Hospital, Doha, Qatar
| | - Yassir Abdulrahman
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Tarriq Siddiqui
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Sajid Atique
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Suresh Kumar Arumugam
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Rifat Latifi
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar; Department of Surgery, University of Arizona, Tucson, Arizona, USA
| | - Hassan Al-Thani
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar
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43
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Anesthetic Considerations and Ventilation Strategies in Cardiothoracic Trauma. CURRENT ANESTHESIOLOGY REPORTS 2016. [DOI: 10.1007/s40140-016-0149-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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44
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Zreik NH, Francis I, Ray A, Rogers BA, Ricketts DM. Blunt chest trauma: soft tissue injury in the thorax. Br J Hosp Med (Lond) 2016; 77:78-83. [DOI: 10.12968/hmed.2016.77.2.78] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Nasri H Zreik
- Orthopaedic Registrar in the Department of Trauma and Orthopaedics, Aintree University Hospital, Liverpool L9 7AL
| | - Irene Francis
- Medical Student in the Department of Medicine and Dentistry, Brighton University, Brighton
| | - Arun Ray
- Orthopaedic Registrar in the Department of Trauma and Orthopaedics, Brighton and Sussex University Hospitals, Brighton, East Sussex
| | - Benedict A Rogers
- Consultant Orthopaedic Surgeon in the Department of Trauma and Orthopaedics, Brighton and Sussex University Hospitals, Brighton, East Sussex
| | - David M Ricketts
- Consultant Orthopaedic Surgeon in the Department of Trauma and Orthopaedics, Brighton and Sussex University Hospitals, Brighton, East Sussex
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45
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Ye JB, Sul YH, Go SJ, Kwon OS, Kim JS, Park SS, Ku GW, Lee MK, Kim YC. Pericardial Tamponade following Perihepatic Gauze Packing for Blunt Hepatic Injury. JOURNAL OF TRAUMA AND INJURY 2015. [DOI: 10.20408/jti.2015.28.3.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Jin Bong Ye
- Department of Surgery, Eulji University Hospital, Daejeon, Korea
| | - Young Hoon Sul
- Department of Surgery, Eulji University Hospital, Daejeon, Korea
| | - Seung Je Go
- Department of Surgery, Eulji University Hospital, Daejeon, Korea
| | - Oh Sang Kwon
- Department of Surgery, Eulji University Hospital, Daejeon, Korea
| | - Joong Suck Kim
- Department of Surgery, Eulji University Hospital, Daejeon, Korea
| | - Sang Soon Park
- Department of Thoracic and Cardiovascular Surgery, Eulji University Hospital, Daejeon, Korea
| | - Gwan Woo Ku
- Department of Thoracic and Cardiovascular Surgery, Eulji University Hospital, Daejeon, Korea
| | - Min Koo Lee
- Department of Surgery, Eulji University Hospital, Daejeon, Korea
| | - Yeong Cheol Kim
- Department of Surgery, Eulji University Hospital, Daejeon, Korea
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46
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47
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Radomski M, Zettervall S, Schroeder ME, Messing J, Dunne J, Sarani B. Critical Care for the Patient With Multiple Trauma. J Intensive Care Med 2015; 31:307-18. [PMID: 25673631 DOI: 10.1177/0885066615571895] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 01/12/2015] [Indexed: 02/06/2023]
Abstract
Trauma remains the leading cause of death worldwide and the leading cause of death in those less than 44 years old in the United States. Admission to a verified trauma center has been shown to decrease mortality following a major injury. This decrease in mortality has been a direct result of improvements in the initial evaluation and resuscitation from injury as well as continued advances in critical care. As such, it is vital that intensive care practitioners be familiar with various types of injuries and their associated treatment strategies as well as their potential complications in order to minimize the morbidity and mortality frequently seen in this patient population.
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Affiliation(s)
- Michal Radomski
- Department of Surgery, Center for Trauma and Critical Care (CTACC), George Washington University, Washington, DC, USA
| | - Sara Zettervall
- Department of Surgery, Center for Trauma and Critical Care (CTACC), George Washington University, Washington, DC, USA
| | - Mary Elizabeth Schroeder
- Department of Surgery, Center for Trauma and Critical Care (CTACC), George Washington University, Washington, DC, USA
| | - Jonathan Messing
- Department of Surgery, Center for Trauma and Critical Care (CTACC), George Washington University, Washington, DC, USA
| | - James Dunne
- Department of Surgery, Center for Trauma and Critical Care (CTACC), George Washington University, Washington, DC, USA
| | - Babak Sarani
- Department of Surgery, Center for Trauma and Critical Care (CTACC), George Washington University, Washington, DC, USA
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48
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Prichayudh S, Kritayakirana K, Samorn P, Pak-art R, Sriussadaporn S, Sriussadaporn S, Kiatpadungkul W, Thatsakorn K, Viratanapanu I. Damage control surgery in blunt cardiac injury. ASIAN BIOMED 2014. [DOI: 10.5372/1905-7415.0801.292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background: Blunt cardiac injury (BCI) is a rare, but life threatening injury. The treatment of BCI is surgical repair. However, in a BCI patient with hypothermia, acidosis, and coagulopathy, an attempt to control the bleeding completely by surgery alone may not be successful. Damage control principles should be used in this situation.
Objective: To study a BCI patient who underwent a successful operation using damage control principles.
Methods: We reviewed and analyzed the patient’s chart, operative notes and follow up visit records. Review of the literature regarding the issue was also conducted.
Results: We report the case of a patient with BCI who developed hypothermia and coagulopathy during surgery. Abbreviated surgical repair was performed with a right pleuropericardial window created to avoid blood accumulation in the pericardial sac. Subsequent aggressive resuscitation was performed in the intensive care unit. We accepted ongoing bleeding through the right chest tubes while correction of hypothermia and coagulopathy was undertaken. The bleeding was gradually stopped once the patient’s physiology was restored. Although the patient developed a retained right hemothorax requiring subsequent video-assisted thoracoscopic surgery on the third postoperative week, he recovered uneventfully and was discharged on postoperative day 36.
Conclusion: In patients with BCI who develop coagulopathy during surgery, terminating the operation quickly and creating a pleuropericardial window is a possible bailout solution because this can prevent postoperative cardiac tamponade without leaving the chest open. Continue bleeding from the chest tubes is acceptable provided that adequate resuscitation to correct coagulopathy is underway.
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Affiliation(s)
| | | | - Pasurachate Samorn
- Department of Surgery, Chulalongkorn University, Bangkok 10330, Thailand
| | - Rattaplee Pak-art
- Department of Surgery, Chulalongkorn University, Bangkok 10330, Thailand
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49
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Abstract
Blunt cardiac injury has a wide spectrum of clinical presentations, some of them quite severe. Its definition varies throughout the literature. The purpose of this review is to describe the epidemiology, screening, diagnosis and management of blunt cardiac injury. Blunt cardiac injury complicates up to 30% of severe blunt force trauma. It can be classified into electrical and structural abnormalities. Screening modalities include electrocardiogram and cardiac enzymes. Serial negative electrocardiograms and troponins can safely rule out blunt cardiac injury. A transthoracic echocardiogram should be performed if persistent dysrhythmia or hypotension. All dysrhythmias should be treated. Patients with structural abnormalities rarely survive. In conclusion, blunt cardiac injury is prevalent after significant blunt trauma. The appropriate screening modalities should be employed and any abnormality to be treated.
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Affiliation(s)
- Emilie Joos
- Division of Trauma and Surgical Critical Care, University of Southern California, Los Angeles, CA, USA
| | - Matthew D Tadloc
- Division of Trauma and Surgical Critical Care, University of Southern California, Los Angeles, CA, USA
| | - Kenji Inaba
- Division of Trauma and Surgical Critical Care, University of Southern California, Los Angeles, CA, USA
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50
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Nhan NH, Anh PTT, Trung TM, Pezzella AT. Blunt traumatic left atrial appendage rupture and cardiac herniation. Asian Cardiovasc Thorac Ann 2014; 22:598-600. [PMID: 24585276 DOI: 10.1177/0218492313479124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 42-year-old man sustained blunt thoracic trauma after a motor vehicle accident. He underwent an urgent operation. Operative findings included a large hematoma, a 4-cm tear in the left atrial appendage, and a long pleuropericardial rupture along the right phrenic nerve. We repaired the left atrial appendage without cardiopulmonary bypass, and closed the pericardial defect primarily. The patient recovered fully and was discharged on the 6th postoperative day.
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Affiliation(s)
- Nguyen Huu Nhan
- Medical and Health Science Center, University of Debrecen, Hungary
| | - Pham Tho Tuan Anh
- Department of Cardiac Surgery, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Tran Minh Trung
- Department of Cardiac Surgery, Cho Ray Hospital, Ho Chi Minh City, Vietnam
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