Percutaneous closure of a complex posttraumatic muscular ventricular septal defect

We report the percutaneous closure of a complex traumatic ventricular septal defect resulting from a stab wound to the anterior chest. The patient presented with heart failure 3 months after the initial trauma. Evaluation revealed a new large ventricular septal defect with diminished cardiac function. Closure was accomplished with a combination of an Amplatzer muscular ventricular septal defect occluder and two Amplatzer vascular plugs. © 2008 Wiley‐Liss, Inc.     

心脏外伤的诊治

目的探讨心脏外伤的诊断及治疗方法。方法分析2000年7月至2006年9月收治的7例心脏外伤患者资料,男性6例,女性1例,年龄18-37岁,其中刀刺伤5例、胸部挤压伤2例、急性心包填塞6例。损伤部位：右心室3例、左心室2例、室间隔破裂1例、单纯急性心包填塞1例。结果急诊手术6例,保守治疗1例,没有死亡病例。结论早期快速诊断、积极抗休克治疗、紧急开胸手术是成功抢救心脏外伤的关键。     

A rare complication of pericardiocentesis: Pneumopericardium

Pneumopericardium is the presence of air in the pericardial sac. Pneumopericardium after pericardiocentesis has been rarely reported in the literature. In the present case, we report a patient who presented with tamponade physiology during COVID-19 and developed pneumopericardium after emergency pericardiocentesis. Immediate recognition and treatment are crucial and chest x-ray, thorax computerized tomography, and transthoracic echocardiography (TTE) are used for diagnosis.     

Delayed pericardial tamponade, mitral insufficiency and VSD after stab wound to the heart

We report a case of delayed pericardial tamponade and presentation of a mitral insufficiency and traumatic ventricular septal defect (VSD) after a cardiac stab wound in an attempted suicide.Delayed tamponade in combination with a VSD and mitral valve injury is a rare complication after a stab wound to the heart. Normal echocardiographic findings, no murmur at admission and relatively benign clinical conditions may be misleading after cardiac trauma. The presented case links the rapid deterioration of the clinical condition and the development of a pericardial effusion to a Valsalva maneuver.     

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.     

Thoracic stab wound with delayed pneumoperitoneum and pneumomediastinum

A 21-year-old man with an innocent-appearing, self-inflicted stab wound to the left upper anterior chest developed pneumoperitoneum and pneumomediastinum seven hours after the injury. At laparotomy he had lacerations of the left hemidiaphragm and anterior wall of the stomach, which were surgically repaired. He recovered without complications. Although brief (four- to six-hour) outpatient observation of patients with seemingly superficial thoracic stab wounds recently has been recommended, this case suggests that longer observation periods for such injuries may be appropriate.     

Traumatic wound of the heart: value of intraoperative colour Doppler flow imaging

A patient who sustained a traumatic ventricular septal defect from a stab wound is presented. Intraoperative echo-Doppler imaging provided an additional diagnosis of avulsion of anterior papillary muscle of the tricuspid valve prior to cardiotomy. It was concluded that intraoperative echo-Doppler imaging proves a useful guide for cardiac surgery following penetrating trauma.     

Large left ventricular pseudoaneurysm presenting 25 years after penetrating chest trauma

Penetrating chest wounds leading to damage of thoracic structures are common. A rare sequelae of chest trauma is a contained rupture of the left ventricle of the heart leading to the development of a pseudoaneurysm. This complication needs prompt recognition and repair because of the high likelihood of rupture and death. We report the case of a 47-year-old man who underwent repair of a stab wound to the heart 25 years ago and subsequently developed a large left ventricular pseudoaneurysm and presented with angina.     

心脏外伤的诊断与治疗

目的:探讨心脏外伤的诊断及治疗方法,提高心脏外伤的抢救成功率。方法:我科于1999年3月至2010年10月共收治10例心脏外伤患者,男性7例,女性3例,年龄18～51岁,平均(29.5±8.5)岁。其中刀刺伤5例,车祸伤3例,高处坠落伤2例。表现为出血性休克者3例,急性心包填塞者7例。损伤部位有:左心室4例,左心房2例,右心室3例,右心耳1例。结果:所有患者手术均取得成功,没有死亡病例。结论:早期快速诊断、紧急开胸手术治疗,及时有效补充血容量,采取自体血液回输,是成功抢救心脏外伤的关键。     

Transthoracic echocardiogram is a useful tool in the hemodynamic assessment of patients with chest trauma

IntroductionThe utility of transthoracic echocardiogram (TTE) in patients on the trauma service is not well defined. The aim of this study was to evaluate the frequency of abnormal echocardiographic findings that would aid in the assessment and management of cardio vascular hemodynamics in patients with chest trauma.MethodsA retrospective analysis of all patients who had a TTE on the trauma service at a level 1 trauma center during a 12-month period was performed.ResultsThere were 94 patients in the study. TTE was performed after cardiac surgery in 5 patients. One of the 5 patients with prior cardiac surgery was excluded from the study because of poor quality images, and each of the remaining 4 patients showed significant TTE abnormalities. Of the 89 patients without prior cardiac surgery, 38 (43%) had significant TTE findings although 32 (84%) of them had no known history of cardiac abnormalities. A decreased left ventricular ejection fraction (< 50%) was found in 18% of all patients, and half of them were hemodynamically unstable. significant valvular regurgitation or stenosis was found in 31 patients, pulmonary hypertension in 25 patients, left ventricular wall motion abnormalities in 12 patients and pericardial effusion in 11 patients.ConclusionSignificant echocardiographic abnormalities are detected by TTE in patients with chest trauma. such findings can be used in the hemodynamic assessment and management of unstable patients during their hospitalization and in planning long-term follow-up and management of these patients after discharge from the hospital.     

The electrocardiogram in traumatic pericarditis: Case report

A case of stab wound of the chest is reported, in which, at operation, which was done to stop bleeding, only a laceration of the parietal pericardium (and lungs) occurred, without trauma to the epicardium, myocardium, or coronary blood vessels. The opportunity of following the electrocardiographic changes in serial records was afforeded. The clinical course and electrocardiographic pattern were those of traumatic diffuse pericarditis. A distinction is made between such electrocardiographic changes and those which occur after localized myocardial necrosis of traumatic origin.     

Chest trauma and subvalvular left ventricular aneurysms

Two patients were discovered to have pulsatile saccular lesions at the base of the left ventricle and mitral regurgitation following blunt trauma to the chest. These aneurysms resembled annular subvalvular aneurysms which have previously been reported as congenital defects in African blacks and as acquired lesions following endocarditis or mitral valve replacement. The first patient had two aneurysms, while the second had an aneurysm in continuity with a traumatic ventricular septal defect. These aneurysms were detected by echocardiography and magnetic resonance imaging and should be sought in patients who develop valvar regurgitation following chest trauma.     

Stab Wound of the Heart with Unusual Sequelae

A 31-year-old woman was admitted to the emergency department with a stab wound to the heart. She was initially stable but rapidly developed hypotension. While the operating room and staff were in preparation, she underwent pericardiocentesis. She was then rushed to the operating room by the general surgical trauma team, who performed a bilateral anterior thoracotomy to control the bleeding. In the recovery room, the patient was still hypotensive, so cardiothoracic surgery was consulted.An echocardiogram revealed severe hypokinesis of both ventricles. The cardiothoracic surgeons returned her to the operating room and discovered that the anterior pericardium had been completely removed by the trauma team. This had caused the posterior pericardium to form a “bowstring” that almost totally obstructed pulmonary venous return and restricted right ventricular outflow of blood, inducing right-sided heart failure. This pericardial string also strangulated the left atrium posteriorly, forming 2 compartments. We repositioned the patient''s heart and implanted ventricular assist devices bilaterally to provide temporary circulatory support. The patient made a good recovery. We suggest that bilateral assist device placement can be beneficial in the recovery of a stunned but otherwise normal heart.Key words: Assist device, left ventricular; assist device, right ventricular; assisted circulation; echocardiography; heart injuries/surgery; hemodynamics; hernia/etiology; pericardium/injuries/surgery; thoracotomy, bilateral anterior; wounds, penetrating; wounds, stab/complications/surgery/therapyPenetrating injuries of the heart have multiple causes: most commonly, gunshot wounds, stab wounds, or blunt trauma. We propose a method to support the stunned and failing heart until recovery can take place, if the heart is otherwise normal. Cardiac herniation can be dangerous and fatal if not recognized as a sequela to emergency department thoracotomy.     

Post-traumatic ventricular septal defect

A 20-year-old male was admitted to the emergency departmentwith a stab wound in his chest in the cardiac region. Given     

经食道超声心动图在成人继发孔ASD封堵治疗中的应用价值

目的：探讨经食道超声心动图（TEE）在成人继发孔房间隔缺损（ASD）介入及外科微创封堵术治疗中的应用价值。方法：以2012年1月至12月间通过经胸壁超声心动图（TTE）及 TEE 筛选的行介入封堵（91例）及外科微创封堵（43例）治疗的134例成人（＞15岁）单纯继发孔 ASD 患者为研究对象,介入组患者术中行 TTE 监护,外科微创组患者术中行 TEE 监护。对术前 TTE 和 TEE 相关参数及手术结果进行对照分析。结果：两组患者ASD 缺损径的 TEE 测值均显著大于 TTE 测值（P 均＜0.01）,最大缺损径的 TEE 测值均显著大于 TTE 测值[（19.8±5.2）mm 比（18.7±4.9）mm],P ＜0.01;最大缺损径的 TTE 测值与封堵器大小间相关性（介入组 r＝0.926,外科微创组 r＝0.215）均低于 TEE （介入组 r＝0.965,外科微创组 r＝0.627）,P 均＜0.01。结论：经食道超声心动图对房间隔缺损的大小评估优于经胸壁超声心动图,应作为成人房间隔缺损封堵患者术前筛查的常规检查,在外科微创封堵房间隔缺损中作为实时监测引导、即刻评价疗效具有重要价值。     

心脏外伤的诊断及治疗

目的:总结分析心脏外伤的诊断和治疗方法。方法:1989年1月至2006年10月,共收治18例心脏外伤患者,男性15例,女性3例,年龄6～55岁,平均(24.4±8.5)岁,刀刺伤10例,车祸伤5例,枪伤3例;急诊入院9例,门诊入院9例。其中诊断创伤性室间隔缺损7例。18例患者均行手术治疗。结果:术后患者恢复良好,无死亡。结论:心脏外伤应尽快确定诊断,即刻手术,提高抢救成功率。合并的室间隔缺损或瓣膜病变,如果不危及患者生命,可以择期手术,以提高手术成功率,减少并发症。     

Electrocardiographic studies of gunshot and stab wounds of the heart

The electrocardiographic studies of two patients with cardiac trauma, one with a gunshot wound of the apex of the left ventricle, and the other with a stab wound of the right auricle, are reported.In Case 1, the electrocardiographic picture of acute anterior coronary infarction is in keeping with the preoperative diagnosis of three wounds, one on the anterior surface and two on the posterior surface of the apex of the left ventricle.In Case 2, with a stab wound of the right auricle, the electrocardiographic changes reveal prolongation of P-R intervals to 0.24 second. The other changes in the electrocardiographic pattern may be attributed to acute pericarditis.     

Blunt trauma as a cause of rib chondro-osteitis: a case study

Rib chondro-osteitis is rare and usually caused by tuberculosis. A 63-year-old man presented with fever, painful swelling, and a burning sensation in the parasternal right submammary region. He had a history of cardiac interventions: percutaneous transcatheter angioplasty with stenting 1 year prior and coronary artery bypass graft surgery 16 years before; therefore, he was on dual antiplatelet therapy. He sustained blunt chest trauma 5 months before admission. A chest wall abscess was suspected and fine needle aspiration of the lesion revealed the presence of purulent fluid. Culture results were positive for Staphylococcus aureus and intravenous antibiotic therapy was started. Computed tomography showed a lesion involving the sternal, chondral, and proximal costal portions of the fourth, fifth, and sixth anterior costal arches. The patient was diagnosed with costal chondo-osteitis following blunt trauma. Following aggressive surgical debridement, the wound was managed with topical negative pressure therapy (constant -125 mm Hg setting with daily dressing changes). After 15 days, culture results were negative, the wound bed contained healthy granulation tissue, and the defect was surgically closed using a myocutaneous flap. No recurrence or complications have been observed during the 2-year follow-up. This is the first reported case of pyogenic, posttraumatic, costal chondro-osteitis secondary to a blunt trauma of the chest wall.     

Percutaneous closure of postoperative and post-traumatic ventricular septal defects

Although uncommon, significant postoperative residual leaks may occur after repair of any type of ventricular septal defect (VSD). Post-traumatic VSDs are even rarer, but can be occasionally seen after penetrating or blunt chest trauma. When these defects are associated with significant left-to-right shunting (Qp/Qs > 1.5) with persistent left ventricular volume overload, intervention is generally recommended. Surgical treatment requires cardiopulmonary bypass with its attendant morbidity, increased hospital stay and possible long-term neurological impairment. With the evolving experience of transcatheter closure of postinfarction and native perimembranous and muscular VSDs, this less invasive method became an attractive alternative to manage these postoperative and post-traumatic defects. In this paper, we report on 3 patients with such residual leaks after repair of a perimembranous defect, which was closed using a perimembranous Amplatzer VSD occluded after a failed attempt using a NitOcclud coil. One patient had a mid-muscular post-traumatic defect after a penetrating chest wound, and another patient had a residual leak after a patch repair of a large post-traumatic muscular defect with outlet extension after a blunt chest trauma. Both defects were closed using muscular Amplatzer VSD occluders. All procedures were uncomplicated, and there were no technical difficulties with device implantation. All 3 patients' defects were completely closed at follow up. Percutaneous closure of traumatic and residual postoperative VSDs appears to be safe and effective. A larger number of patients and longer follow-up period are needed before the widespread use of this technique can be recommended.     

Traumatic thoracic aorta-innominate vein fistula: a case report

Traumatic thoracic aorta-innominate vein fistulae are very rare. We present the case of a 20-year-old woman who sustained a stab wound to the left side of the chest. The physical examination was unremarkable. A chest radiograph showed a widened mediastinum, and arteriography demonstrated an arterio-venous fistula involving the thoracic aorta and the innominate vein. Operative repair was accomplished and the patient recovered.