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.     

Spontaneous resolution of an accidental total coronary occlusion

In December 2007, a woman was involved in a traffic accident. At first, her vital signs were normal, but electrocardiogram showed ST-segment elevation in the inferior leads. She was diagnosed as a blunt chest trauma-induced myocardial infarction. Her right coronary angiography showed total occlusion. She underwent an emergency coronary artery bypass surgery; 64-multi-detector-row computed tomography (64-MDCT) demonstrated an intravascular protruding lesion, which suggested subintimal hematoma. One month later, repeat coronary angiogram showed spontaneous recanalization, and 64-MDCT showed no discontinuous vessel wall. Coronary artery occlusion secondary to blunt chest trauma is rare, and it's even rarer to have spontaneous recanalization.     

Obstruction of the proximal right coronary artery with acute inferior infarction due to blunt chest trauma.

Two patients developed an acute transmural myocardial infarction due to severe obstruction of the proximal right coronary artery after blunt chest trauma. Neither had a history of ischemic heart disease, and both had an arteriographically normal left coronary artery. In one patient significant resolution of the subtotal obstruction occurred within 3 months. An intimal tear or subintimal hemorrhage with luminal thrombosis, or both, are the suggested mechanism of coronary arterial occlusion. Spasm and platelet aggregates may contribute. Despite a large number of automobile accidents, obstruction of the right coronary artery due to blunt chest trauma has not been previously described. This suggests it has been overlooked and should be especially suspected in persons with injury to the sternum and an acute inferior myocardial infarction.     

Post-traumatic coronary occlusion and early left ventricular aneurysm.

A case of post-traumatic coronary occlusion is presented. A 38-year-old sustained a blunt chest trauma with secondary transmural infarct and early evolution toward a huge left ventricular aneurysm. Coronary arteriography showed complete occlusion to the left anterior descending coronary artery.     

Left coronary artery aneurysm and anteroseptal acute myocardial infarction following blunt chest trauma

After a suicide attempt (fall from the ninth floor) a 28-year-oldman presented with a blunt chest trauma. Electrocardiographicand enzymatic changes were characteristic of an acute anteroseptalmyocardial infarction. A thallium myocardial scan showed decreaseduptake of thallium over the septal area. Coronary angiographyperformed 6 weeks after the injury demonstrated aneurysmal dilatationof the left anterior descending artery which was patent, intramyocardialhaemorrhage in the septum, and septal akinesia. The other leftand right coronary arteries were normal. The patient remainedasymptomatic 8 months later under medical treatment.     

Traumatic dissection of the circumflex coronary artery complicating a myocardial contusion. A case report

Myocardial contusion can result in lethal complications as myocardial infarction, tamponade and acute valvular lesions. Following blunt thoracic trauma, the diagnosis is often difficult to make because of the multiple associated injuries. We report the case of a 42-year-old woman who, after a blunt chest trauma, developed a tamponade, an acute transmural myocardial infarction and an acute mitral regurgitation. Coronary arteriography revealed a dissection in the circumflex artery.     

Survival with total occlusion of the left main coronary artery. Significance of the collateral circulation

Four patients with total occlusion of the left main coronary artery are described. Angina pectoris was severe (NYHA class 3-4) and had lasted 20 months to seven years. Three patients had experienced a myocardial infarction. All displayed large collaterals arising from a nearly normal right coronary artery and feeding both the left anterior descending and the left circumflex arteries. The left ventricular ejection fractions ranged from 20% to 65%, and all patients had varying degrees of left ventricular asynergy. Coronary artery bypass surgery resulted in a marked improvement in three patients; one patient who underwent an aneurysmectomy died two months after the operation. The data show that total occlusion of the left main coronary artery is compatible with survival if adequate collateral supply develops from the right coronary artery. In this rare angiographic subset collateral circulation is clearly functionally significant.     

Coronary dissection following chest trauma with systemic emboli

Coronary artery dissection is a rare entity which occurs following blunt chest trauma, during coronary angiography and coronary bypass surgery, and spontaneously in the peripartum period. We report a young man who presented with recurrent systemic emboli following an asymptomatic anterior wall myocardial infarction associated with dissection of the LAD and mural thrombus three years earlier after sustaining blunt chest trauma.     

胸部钝性外伤性急性心肌梗塞2例报告及文献复习

本文报告2例青年于胸部钝性外伤后出现心肌异常Q波和损伤性ST段抬高，其心电图和心肌酶学的演变与典型的急性心肌梗塞（AMI）相同。胸部钝性外伤致AMI的主要机理为冠状动脉内膜扯裂、内膜下出血、血栓形成以及粥样斑块扯裂而导致冠状动脉阻塞，受累最多的是左前降支。由于常伴体表、心脏或其它脏器的挫伤或损伤，全身抗凝或静脉溶栓治疗通常为禁忌。如病人条件允许，可施行冠脉搭桥、PTCA或冠状动脉内溶栓等治疗。     

Acute myocardial infarction caused by coronary artery dissection after a blunt chest trauma

Acute myocardial infarction is a life-threatening condition. Coronary dissection after blunt chest trauma is a rare event. Chest pain is a common symptom after chest trauma, which may relate to chest contusion without cardiac injury or myocardial infarction. Differentiation between minor cardiac contusion and significant cardiac injury is difficult and it is a challenge for physicians to diagnose traumatic cardiac injury early. We report a case of a 40-year-old man suffering from coronary artery dissection after a blunt chest trauma and intracranial hemorrhage after percutaneous coronary intervention.     

Traumatic total occlusion of left main coronary artery caused by blunt chest trauma

Myocardial infarction is a rare complication that can occur immediately after a blunt chest trauma. We report a 36-year-old male who experienced a fatal anterolateral myocardial infarction after a nonpenetrating chest injury sustained in a car accident. Injuries of the coronary arteries associated with blunt chest trauma predominantly affect the left anterior descending artery. This is the first case of traumatic complete occlusion of the left main coronary artery (LMCA) demonstrated by coronary angiography.     

Intravenous verapamil therapy in imminent myocardial infarction

We studied 16 patients with small myocardial infarction who had further episodes of chest pain with ST-segment elevation, a sign of transmural myocardial ischemia and imminent infarction extension. Coronary angiography in 14 showed a critical lesion in 13. Intravenous verapamil abolished chest pain and ST-segment elevation. It caused a fall in right atrial and left ventricular end-diastolic pressures (LVEDP) and cardiac output, reflex systemic vasoconstriction, and a rise in systemic vascular resistance. There was no reflex tachycardia. Volume expansion raised LVEDP and restored a normal cardiac output. Accelerated junctional rhythm with isorhythmic A-V dissociation occurred in 5 patients. Two patients sustained a transmural infarction, 10 underwent coronary artery bypass grafting, and 4 are symptom-free with oral treatment. Intravenous treatment was an effective method of treating acute episodes of transmural myocardial ischemia and preventing their recurrence in patients with critical coronary artery narrowing. Continuous verapamil infusion stabilized the patients' condition and enabled smooth coronary angiography and induction of anesthesia for surgery.     

Acute anterior wall myocardial infarction secondary to blunt chest trauma

We report here a young patient who developed an acute transmural anterior wall myocardial infarction secondary to blunt chest trauma in an automobile accident. At angiography we demonstrated that this patient had sustained a left anterior descending branch intimal tear (Figure 1). Closed chest wall injury with myocardial contusion is a common occurrence in automobile accidents. However, the occlusion of the coronary artery from blunt chest trauma is rare in itself.     

Bilateral coronary dissection after blunt thoracic trauma: a case report

We describe a case of a 43-year-old male who had blunt chest trauma in a previous traffic accident. He presented shortness of breath and palpitation on mild exertion 1 month later. Echocardiography showed dilated left atrium and ventricular with reduced left ventricular ejection fraction. Coronary angiography revealed a dissection of the left anterior descending coronary artery with impaired blood flow and diffuse dissection from proximal to mid right coronary artery. To our knowledge, this is the first case presenting cardiac insufficiency secondary to bilateral coronary artery dissection after blunt trauma.     

Progression from stenosis to occlusion in the proximal native coronary artery after coronary artery bypass grafting

Coronary artery bypass grafting (CABG) is an established treatment for multivessel coronary artery disease. However, problematic situations are occasionally encountered after CABG, such as disease progression in the native coronary artery with graft occlusion, which causes difficulty in revascularization. The purpose of this study was to evaluate changes in the native coronary artery after CABG. Between 2009 and 2012 in our institution, 351 patients underwent CABG, and 768 bypass grafts were anastomosed to non-occluded coronary arteries. Of these, 489 bypass grafts had available early postoperative angiographic results (≤6 months) suitable for assessment in this study. We defined malignant graft failure after CABG to be bypass graft occlusion and de novo complete occlusion of the target native coronary artery proximal to the graft anastomosis site. In the early angiographic results, 17 grafts were occluded (17/489; 3.5 %). Two of the grafts displayed malignant graft failure (a saphenous vein graft to the right coronary artery and a saphenous vein graft to the diagonal branch) (2 of 17 occluded grafts, and 2 of 489 studied grafts). Of the patent bypass grafts, 24 involved progression to occlusion in the proximal native coronary artery (19 saphenous vein grafts, 4 left internal thoracic artery grafts, and 1 right internal thoracic artery graft). Malignant graft failure was uncommon during short-term follow-up after CABG. At the same time, disease progression in the proximal native coronary artery from stenosis to occlusion following patent bypass grafting was relatively common, especially for vein grafts.     

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.     

Left main dissection complicating blunt chest trauma: Case report and review of literature

Coronary artery injury after blunt chest trauma is rare, but can be life-threatening, resulting in severe myocardial ischaemia and acute myocardial infarction. We report a case of a 56-year-old male who presented a few days after a blunt chest trauma with crescendo unstable angina. Coronary angiography demonstrated left main coronary artery dissection that was fixed with stent implantation. After a blunt chest trauma symptoms and electrocardiographic findings of a coronary dissection can be nonspecific and confounded by the chest tenderness. In such cases careful evaluation to rule out traumatic coronary injuries is warranted and early intervention should not be delayed in the presence of clear evidence of myocardial ischemia.     

Complete occlusion of the left main coronary artery: clinical and angiographic observations in five cases

Involvement of the left main coronary artery is observed in approximately 5 to 8% of patients with coronary artery lesions detected by coronary angiography, but occlusion of the left main artery is a very infrequent finding. Out of approximately 4000 patients undergoing coronary angiography, four men and one woman, 37 to 60 years old, showed total occlusion of this vessel. Four of them had angina pectoris and three had had a myocardial infarction. All five showed deep ST depression in V 2(or 3)-6 during bicycle exercise testing. Apart from the left main artery occlusion, all had significant obstructive lesions in other coronary vessels, including the right coronary artery or its major branches. There was collateral circulation from the right coronary artery in all patients. Left ventricular function was well preserved in three patients and markedly impaired in two. Four patients underwent bypass surgery and they have been followed for 10 to 28 months. Three are free of angina and one has only minimal angina. One patient refused surgery and he continued to have severe angina despite intense medical treatment. He died suddenly after 30 months follow-up. In patients with complete occlusion of the left main coronary artery, development of adequate collateral flow seems important in preserving left ventricular function, but collaterals are usually insufficient to prevent angina. Moreover, associated obstructive lesions in other coronary arteries constitute a potential threat to the collateral circulation. Effective symptomatic relief is obtained by coronary bypass grafting, and revascularization may also improve prognosis in this subset of patients with coronary heart disease.     

Thyrotoxicosis with coronary spasm that required coronary artery bypass surgery

We describe a 47-year-old woman with severe coronary vasospasm induced by hyperthyroidism. The patient complained of anginal chest pain without specific characteristics of thyrotoxicosis. Coronary arteriography was performed and revealed 90% stenosis of both the left and right coronary os. She was treated with emergent coronary artery bypass graft surgery. Postoperatively, she exhibited a comatose mentality. Severe thyrotoxicosis was indicated on thyroid function tests and thyrotoxic storm was diagnosed. Nineteen days after the surgery and following the initiation of propylthiouracil treatment, coronary arteriography revealed entirely normal coronary arteries.     

Minimally invasive direct coronary artery bypass plus coronary stent for acute coronarysyndrome: a case report

A 69-year old female patient was admitted because of 3 days of worsened chest pain.Coronary angiography showed 60% stenosis of distal left main stem,chronic total occlusion of left anterior descending (LAD),70% stenosis at the ostium of a small left circumflex,70-90% stenosis at the paroxysmal and middle part of a dominant right coronary artery (RCA),and a normal left internal mammary artery (LIMA) with normal origination and orientation.Percutaneous intervention was attempted but failed on the occluded lesion of LAD.The patient received minimally invasive direct coronary artery bypass (MIDCAB) with left LIMA isolation by Davinci robot.Eleven days later,the RCA lesion was treated by Sirolimus Rapamicin eluting stents implantation percutaneously.Then the patient was discharged uneventfully after 3 days hospitalization.Our experience suggests that two stop shops of hybrid technique be feasible and safe in the treatment of elderly patient with multiple coronary diseases.