RESUMEN
In this case report, we provide insight into how we managed this case of a large traumatic ventricular septal defect and concomitant tricuspid valve insufficiency with a transatrial approach to ensure a successful repair.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Defectos del Tabique Interventricular , Traumatismos Torácicos , Heridas no Penetrantes , Humanos , Válvula Tricúspide/cirugía , Traumatismos Torácicos/complicaciones , Traumatismos Torácicos/cirugía , Heridas no Penetrantes/complicaciones , Heridas no Penetrantes/cirugía , Defectos del Tabique Interventricular/cirugía , Defectos del Tabique Interventricular/etiologíaRESUMEN
BACKGROUND: Life-threatening conduction abnormalities after penetrating cardiac injuries (PCIs) are rare, and rapid identification and treatment of these arrhythmias are critical to survival. This study highlights diagnosis and management strategies for conduction abnormalities after PCI. METHODS: Patients with life-threatening arrhythmias after PCI were identified at an urban, level I trauma center registry. RESULTS: Seventy-one patients survived to reach the hospital after PCI. Of these, 3 (4%) survivors (male = 3, mean age 41.3, median injury severity score = 25) had critical conduction abnormalities after cardiorrhaphy. All patients had multichamber and atrioventricular nodal injury. After initial cardiorrhaphy and control of hemorrhage, all patients had sustained hypotension with bradycardia from complete heart block. Two patients had ventricular septal defects requiring repair. All 3 patients survived. CONCLUSIONS: Rapid recognition of injury to the cardiac conduction system after PCI as a source of sustained hypotension is essential to early restoration of cardiac function and survival.
Asunto(s)
Síndrome de Brugada/diagnóstico , Síndrome de Brugada/terapia , Estimulación Cardíaca Artificial , Lesiones Cardíacas/cirugía , Heridas Penetrantes/cirugía , Adulto , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/etiología , Arritmias Cardíacas/terapia , Síndrome de Brugada/etiología , Trastorno del Sistema de Conducción Cardíaco , Procedimientos Quirúrgicos Cardíacos , Lesiones Cardíacas/terapia , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Sistema de Registros , Centros Traumatológicos , Población Urbana , Heridas Penetrantes/complicaciones , Heridas Penetrantes/terapiaRESUMEN
Blunt thorax trauma may produce a variety of cardiac lesions, which may occur alone or in combination. Nonpenetrating perforation of interventricular septum with chordae rupture of tricuspid valve is a infrequent pathologic event. A 40-years-old worker was transfered to hospital with increasing symptoms of right heart failure following a blunt compressing chest trauma with a huge overolling cement pipe(Wt.680kg) 6 weeks ago. The immediately diagnosed serial rib fracture of the left thorax cage and dislocation of the left acromoclavicular joint were treat conservatively. A conventional transthoracic color Doppler and two dimensional echocardiogram detected traumatic ventricular septal defect with bilatral shunt and tricuspid regurgitation. An additional transesophageal color echocardiopraphic demonstrated the ruptured chordae tendineae of the tricuspid septal leafet, which prolapsed deeply into the right atrium. The conventional color Doppler echocardiopraphy enhances the ability to detect the presence of a ventricular septal perforation and valve dysfunction in a patient with cardiac contusion. The transesophageal echocardiopraphy is a useful semiinvasive tool for the detailed morphological evaluation of atrioventricular valves and their substructure.