Ectopia Cordis with a Double Outlet Right Ventricle,Large Ventricular Septal Defect,Malposed Great Arteries and Left Ventricular Hypoplasia

Ectopia cordis, defined as partial or complete displacement of the heart outside of the thoracic cavity, is a rare congenital malformation. If not surgically corrected during the early years of life, ectopia cordis can prove to be a fatal abnormality. However, due to the presence of multiple intracardiac and extracardiac malformations, a corrective surgery might not always be successful. The pathology of ectopia cordis with a double outlet right ventricle, large ventricular septal defect, malposed great arteries and left ventricular hypoplasia is discussed, highlighting the complexities involved in such a rare disorder.     

Pentalogía de Cantrell. Reporte de un caso en el Hospital San Vicente de Paúl de Ibarra,Ecuador

Cantrell's Pentalogy, and also called peritoneum-pericardial diaphragmatic hernia, is a rare syndrome that includes five basic defects of the heart, sternum, supra-umbilical abdominal wall, diaphragm, and pericardium. Its incidence is approximately 1 for every 200,000 births, with a male predominance with a ratio of 1.35: 1. Doctors Cantrell, Haller and Ravitch described this pathology in 1958 and recently a hexalogy was proposed, adding the presence of a single umbilical artery to the diagnosis. The case is presented on a 20-year-old woman in a 26.3 weeks pregnancy in whom the foetus developed Cantrell's Pentalogy associated with transposition of the great vessels.PurposeThis article aims to describe a case of Cantrell's Pentalogy with a review of its physiopathology, diagnostic data, classification, and management.Methods/Search strategyReview of the patient's clinical history in the gynaecology and obstetrics service of the San Vicente de Paul Hospital in Ibarra - Ecuador.ResultsObstetric ultrasound showed a foetus of 26 weeks of gestation, with a chest wall defect of 2.84 cm at the axial section that caused complete cardiac ectopy, as well as an upper abdominal wall defect of 4.3 cm at the cross section that produced a protrusion of the liver parenchyma. In the cardiac ultrasound transposition of the great vessels could be seen, and was classified as Cantrell's Pentalogy type I. Termination of pregnancy was decided due to incompatibility with life, obtaining a male newborn in whom the thoracic and abdominal defects were verified, and died within a few minutes.Implications for practiceHighlights the importance of structural or morphological ultrasound, between 18 to 24 weeks, to detect major congenital malformations, obtain an accurate diagnosis and timely management.Implications for researchMore studies are required to determine the aetiology and management of these patients, because cases of survival are reported.     

First trimester sonographic diagnosis of ectopia cordis: a case report and review of the literature

A case of ectopia cordis (EC) with gastroschisis in a 27-year-old primigravida was diagnosed at 10^3/7 weeks of gestation. The pregnancy was terminated by suction dilatation and curettage. With the increasing use of first trimester ultrasonography, early detection of fetal abnormalities is becoming more frequent. We review other published cases of EC detected in the first trimester and discuss the possible advantages of early diagnosis including options of termination at earlier gestational ages which might decrease the physical and psychological trauma on some patients.     

Ectopia cordis: A rare congenital anomaly

Ectopia cordis (EC) is a rare congenital anomaly associated with the heart positioned outside of the thoracic cavity either partially or completely. The ectopic heart can be found along a spectrum of anatomical locations, including the cervical, thoracic and abdominal regions and in most cases, it protrudes outside the chest through a split sternum. Although the first case of EC was identified during the early 1600s only 91 cases have been reported since then in the literature. This review will discuss the history and prevalence of EC, its etiology, morphology, presentation and symptoms, complications, diagnosis, treatment and management and prognosis. Clin. Anat. 27:1193–1199, 2014. © 2014 Wiley Periodicals, Inc.     

Commotio cordis après impact précordial de Flashball

Less lethal weapons, like Flashball^®, are more and more used since 1995 in law enforcement, even by the local police to neutralize combative individuals and to disperse riot crowds. This gun fires large rubber bullets and has been incriminated many times in cases of face injuries with functional consequences. In this case report, we mention a case of sudden death from cardiac arrest due to low energy chest wall impact of a rubber bullet shot with the Flashball. Commotio cordis is potentialized by a lethal set of three including, a certain impact velocity, an exact location of the hit over the cardiac silhouette, and a precise timing 15 m/s prior to the peak of the T-wave. This case report highlights the fact that such impacts can cause significant injury to internal organs, in particular circonstances, implying the necessity of a raising awareness of the medical staff, in ordre to not underestimate the severity of such injuries.     

Commotio Cordis and complete heart block: Where is the block level?

Ventricular fibrillation is typically the initial arrhythmia in commotio cordis following precordium impacts that occur within an electrically vulnerable period of the cardiac cycle. Conversely, complete heart block is very rare in this context, and its mechanism and temporal course are poorly understood. The presented case concerns a 12-year-old boy, athletic skier, who developed a transient complete heart block following commotio cordis. The electrocardiographic features, the proposed block level and mechanisms of complete heart block following commotio cordis are discussed.     

A Case of Commotio Cordis Treated with Therapeutic Hypothermia

Background

Therapeutic hypothermia is used as a neuroprotective strategy for patients who have persistent neurologic compromise after return of spontaneous circulation from cardiac arrest. The 2010 American Heart Association Guidelines recommend the use of therapeutic hypothermia in adult cardiac arrest patients when the initial rhythm is ventricular fibrillation. These recommendations are based on primary research in patients with a cardiac cause of their ventricular fibrillation.

Case Report

A 43-year-old male was brought to our emergency department (ED) with commotio cordis. He was struck in the chest with a baseball bat, after which he collapsed at the scene and was pulseless. Return of spontaneous circulation was achieved after defibrillation by treating paramedics, and the patient remained comatose on arrival to the ED. He was transferred to the intensive care unit and treated with therapeutic hypothermia at target temperature of 32−34°C. He was extubated on day 3, and discharged home on day 8 with good neurologic function.

Why Should An Emergency Physician Be Aware of This?

We report a case of commotio cordis in which the adult patient was treated with therapeutic hypothermia and had a favorable outcome. To our knowledge, this is the first reported case of its kind. Evidence for the use of therapeutic hypothermia is incomplete in patients with a traumatic cause of cardiac arrest, such as commotio cordis, despite probable similarities in the pathophysiology of anoxic brain injury. Our case illustrates that there may be benefit from use of therapeutic hypothermia for a broader population than is currently recommended.     

冠心病心绞痛的中医辨证论治

冠心病心绞痛,其临床表现与中医心阳不振、气滞血瘀等引起的症状极为相似。因此中医把它归属于“胸痹”、“心痛”、“厥心痛”、“真心痛”等范畴。兹就该病的中医辨证论治分述如下。１　病因病机　　本病多因中老年脏腑功能渐衰,高粱厚味损伤脾胃,或七情内伤所致气滞、血瘀、痰浊内生,使脉络不通,不通则痛而发病〔１〕。《金匮要略·胸痹心痛短气病脉证治》认为：“胸痹”的主要表现为胸中气塞,心痛,短气,其病理关键为胸部的“阳气”极虚所致;故临床上往往表现出本虚标实之病证〔２〕。本虚以脏气亏虚为主;标实以血瘀痰阻为多见…