Blunt Chest Trauma Resulting in Both Atrial and Ventricular Septal Defects

Cardiac septal defects are known complications to blunt chest trauma. The incidence of a traumatic isolated atrial septal defect is unknown and the concurrent occurrence of nonlethal ventricular and atrial septal defects has not been reported. A healthy male sustained violent blunt chest trauma resulting in traumatic cardiac septal disruption in the atrium and ventricle. The defects were detected by echocardiography within 14 hours of the accident. The extent of damage was confirmed at the time of surgical repair. The patient recovered uneventfully. The diagnosis and management of concurrent ASD and VSD is similar to single septal injury.     

Unusual localisation of a ventricular septal defect following blunt chest trauma

A 64 year old man presented with a traumatic ventricular septal defect following blunt chest trauma 40 years before. Echocardiography and left ventriculography were helpful in locating the unusual septal defect, which was subpulmonary. The shunt was small, but the anomalous chronic overload led to right ventricular failure. The surgical correction was thus too late to improve right ventricular function.


Keywords: ventricular septal defect; blunt chest trauma; heart failure     

Post-traumatic ventricular septal defect following coronary bypass surgery

A 60-year-old patient underwent triple coronary artery bypass grafting following an inferoseptal myocardial infarction and early onset of exertional angina. Four years later he was involved in a car accident during which he sustained an abdominal and thoracic trauma. Approximately 1 month after discharge, a ventricular septal defect was diagnosed by two-dimensional Doppler echocardiography with patency of all grafts at coronary angiography. Closure of the septal defect was successfully accomplished through a right atrial approach. Rupture of the ventricular septum following blunt chest trauma in a patient with previous myocardial revascularization has not been previously reported.     

The risk of percutaneous chest tube thoracostomy for blunt thoracic trauma

Analysis of 164 percutaneous chest tube thoracostomies performed as a standardized technical procedure in the management of 129 blunt trauma victims demonstrated an overall complication rate of 9.1% (15 of 164). Three complications (1.8%) were related to problems of insertion, and four (2.4%) represented the problem of pneumothorax after chest tube removal. The remaining eight complications (4.9%) were associated with positive bacterial cultures, two (1.2%) of which represented clinical empyema. Both cases of empyema had either prolonged chest tube placement (23 and 15 days) or multiple chest tubes (two and three) on the same side. Percutaneous chest tube thoracostomy remains an important facet in the management of certain types of blunt thoracic trauma. Associated risks can best be minimized with adherence to a standardized technique and management protocol.     

Traumatic ventricular septal defect and mitral insufficiency after a Kebab's shish wound to the chest.

Transthoracic echocardiography has an important role in the assessment of patients with penetrating chest trauma. We report the case of 19-year-old boy who sustained a kebab's shish wound to the chest. Transthoracic echocardiography revealed a defect in the interventricular septum and a defect in the anterior mitral valve. Both of them were closed with direct sutures.     

Myocardial contusion presented as acute myocardial infarction after chest trauma

A 46-year-old male patient developed an acute myocardial infarction and congestive heart failure following blunt chest trauma. Electrocardiogram (ECG) revealed acute anterior myocardial infarction. Echocardiography showed akinesis of interventricular septum, dyskinesis in apical anterior wall, and severe impairment of left ventricular overall systolic function. Coronary angiography revealed normal coronary arteries. The patient followed a low-intensity physical medicine rehabilitation program. Follow-up was without new complications or deterioration of congestive heart failure. Five months later the patient presented with fulminant acute pulmonary edema and cardiogenic shock. Cardiopulmonary resuscitation was unsuccessful.     

Traumatic disruption of the brachiocephalic artery

We report the case of a patient presenting with blunt chest and head injuries. Initial emergency department evaluation revealed a pulmonary contusion and suspected closed head injuries. Computed tomographic scan of the head was unremarkable. An angiogram performed to further investigate the nature of his head injuries revealed a disruption of the brachiocephalic artery. The lesion was surgically repaired in the operating room and the patient was moved to the intensive care unit, where he remained comatose and died from complications of his head and chest injuries on the seventh post-operative day. The pathophysiology and clinical manifestations of injuries to the brachiocephalic artery are discussed.     

Tension pneumopericardium following blunt chest trauma

A 12-year-old victim of an automobile-pedestrian accident appeared to develop severely compromised cardiac output shortly after intubation and positive pressure ventilation. Anteroposterior and lateral chest films showed air within the pericardial sac. After pericardiocentesis and withdrawal of air, cardiac function improved markedly as evidenced by a rise in blood pressure and a slowing of the pulse. A catheter was left in the pericardial sac for several days. The patient remained hemodynamically stable throughout the hospital stay and was subsequently discharged. Documentation of this degree of tamponade from air in the pericardium is quite uncommon.     

Acute myocardial infarction following blunt chest trauma

A 32-year-old male riding a motorcycle was involved in an accidentresulting in blunt torso trauma. He had fractures of the skull,first right rib, and left femoral bone. Electrocardiogram showedacute anteroseptal myocardial infarction (MI). Subsequent coronaryangiogram demonstrated laceration at the proximal portion ofthe left anterior descending coronary artery. Echocardiogramshowed depressed left ventricular function as well as hypokinesisover septal and apical areas. His recovery was smooth.     

Chest pain in a young basketball player

A 32-year-old man was elbowed in the chest while fighting for a rebound in a recreational basketball game. He fell to the ground and his chest ached from the blow. Four days later he developed more severe chest pressure with dyspnea and came to the hospital. His chest wall was tender and his pulse slow, but the remainder of his physical examination was normal. Electrocardiogram showed sinus bradycardia, first-degree atrioventricular (AV) block, and occasional isorhythmic AV dissociation, but no ischemic ST-T changes. Cardiac troponin I rose to 1.74 ng/mL (normal <0.50). The patient therefore underwent coronary angiography, showing spiral dissection of the right coronary artery with extensive thrombus filling the distal portion of the vessel. Stenting was unsuccessful in restoring flow. This case highlights the potential dangers of blunt chest trauma in recreational sports and shows how angiography can distinguish myocardial contusion from coronary artery dissection.     

The role of Doppler echocardiography in the diagnosis, follow-up, and management of ventricular septal defects

The defects of the ventricular septum have received special attention from investigators working in echocardiography. The method showed an incomparable capability to identify all the morphological features of the defects. The increasing improvement in definition of transducers associated with conventional and color Doppler contributed significantly to the reliability to detect most of the defects. The great majority of associated lesions can be easily identified and serial examinations allow prediction of which defect may become smaller or even close spontaneously as well as which have acquired deleterious changes in the heart. Several authors have shown very good statistical correlations between echocardiographic indices and hemodynamic parameters in patients with this type of defect. Doppler echocardiography has become an invaluable tool in the diagnosis and follow-up of ventricular septal defect reducing the need for cardiac catheterization and helping management of these patients.     

室间隔缺损介入治疗五年临床随访分析

目的 总结分析室间隔缺损(VSD)介入治疗后的随访结果,重点分析其并发症发生情况.方法 2002年11月至2007年11月,共有445例膜周部VSD患者接受了介入封堵术,其中男性203例,女性242例,年龄2.5～58(14.2±6.8)岁.所有患者均经股静脉途径放置封堵器,采用的VSD封堵器包括进口偏心伞及国产对称伞.所有患者术后1、3、6、12个月(其后相隔1年)进行门诊随访,复查超声心动图、X线胸片、心电图.结果 共有417例患者封堵成功,总技术成功率93.7%(417/445),未发生与手术相关的死亡.至2008年2月,平均随访25.6个月(3个月～5年),严重并发症发生率为2.2%(10/445),其中包括三度房室传导阻滞安装永久起搏器2例、左束支传导阻滞伴左心室增大2例、中-大量主动脉瓣反流2例、中量三尖瓣反流2例、中量二尖瓣反流1例、溶血1例.术后5年有7例患者仍存在少量残余分流,总完全封堵率为98.3%(410/417).结论 VSD介入治疗总体上安全有效.应注意适应证的选择和术后严格随访,以减少严重并发症及晚期并发症的发生.     

Hemoptysis following blunt trauma: case report

A 9-year-old boy developed significant hemoptysis and pulmonary parenchymal injury following blunt trauma. There was delayed development of hemoptysis following chest injury, and the trauma did not produce any evidence of external body injury.     

广东省某三甲医院房间隔缺损和室间隔缺损患者住院状况分析

目的 通过对广东省某三甲医院2003年1月至2011年12月房间隔缺损（房缺）和室间隔缺损（室缺）患者住院状况分析,研究先天性心脏病（先心病）住院费用的影响因素,为房缺和室缺患者疾病经济负担控制提供建议.方法 按照房缺和室缺的临床诊断标准,排除有次要诊断的患者,回顾性分析2003年至2011年房缺和室缺患者的住院状况资料.结果 2003年至2010年间房缺患者和室缺患者以儿童为主（86.2％）,男女比为1.34∶1,房缺和室缺的治愈率分别为99.4％和98.6％,房缺和室缺的住院费用在30 001～43 000元为主,性别X1、年龄X2、住院年份X3、住院天数X4、手术方式X5是影响房缺和室缺患者住院费用的主要因素,其Logistic回归模型房缺为logit2/1 =795.893 ＋0.792X2-0.393X3 ＋0.853X4-3.375X5和logit3/1 =2 236.254 ＋0.787X2-1.107X3 ＋1.464X4-7.762X5;室缺为logit2/1 =444.432-0.2 270.324 X3 ＋0.844 X4＋3.365X5,logit3/1 =1 277.419 ＋0.517X2 ＋0.135X3-0.135X4-3.435X5.结论 房缺和室缺患者住院费用逐年下降（β＜0）,应结合可控因素与不可控因素,进一步降低住院费用.     

Traumatic thrombosis of the left main coronary artery and myocardial infarction caused by blunt chest trauma

We report the case of a 38-year-old man who, after a blunt chest trauma, developed an acute transmural myocardial infarction. Coronary arteriography revealed a thrombus in the left main artery, occlusion of the distal left anterior descending artery, and a diagonal branch caused by emboli.     

Blunt abdominal trauma causing jejunal rupture

Two cases of jejunal rupture from blunt abdominal trauma are described. One followed a motorcycle accident, and the other followed a punch to the abdomen. Both patients initially had unremarkable abdominal examinations. After surgical repair of the ruptures, the patients recovered uneventfully. Jejunal rupture secondary to blunt abdominal trauma is not common, but its subdued clinical presentation and the nonspecific laboratory findings make diagnosis difficult. High morbidity and mortality are associated with this type of injury when diagnosis and treatment are delayed. Small bowel rupture should be considered in any patient with a history of significant blunt abdominal trauma and persistent abdominal pain.     

Should the emergency IVP be used more selectively in blunt renal trauma?

A retrospective study was performed to determine if the emergency intravenous pyelogram (IVP) is being overused in the evaluation of blunt renal trauma. Medical records of 105 blunt renal trauma patients undergoing IVPs for suspected blunt renal trauma were analyzed. Eighty-eight patients (83.8%) had normal IVPs, and 17 patients (16.2%) had abnormal IVPs. Three of the 105 patients (2.9%) required urologic surgical intervention. The medical records of these patients were examined in detail because it was believed that this patient population needed to be identified by emergency IVP. All three patients requiring urologic surgery had gross hematuria. All three patients had one or more associated injuries. Two of the three patients had flank tenderness and/or flank mass. The third patient was obtunded. From this study and information from the literature an algorithm has been constructed as a guideline for a prospective study. Following this guideline no patients in the study requiring urologic surgical intervention would have been missed. Of patients requiring an emergency IVP, 7.3% would have required urologic surgery. This would have resulted in a savings of $10,432 at our institution.