RESUMEN
Purpose To clarify the predominant causative plaque constituent for periprocedural myocardial injury (PMI) following percutaneous coronary intervention: (a) erythrocyte-derived materials, indicated by a high plaque-to-myocardium signal intensity ratio (PMR) at coronary atherosclerosis T1-weighted characterization (CATCH) MRI, or (b) lipids, represented by a high maximum 4-mm lipid core burden index (maxLCBI4 mm) at near-infrared spectroscopy intravascular US (NIRS-IVUS). Materials and Methods This retrospective study included consecutive patients who underwent CATCH MRI before elective NIRS-IVUS-guided percutaneous coronary intervention at two facilities. PMI was defined as post-percutaneous coronary intervention troponin T values greater than five times the upper reference limit. Multivariable analysis was performed to identify predictors of PMI. Finally, the predictive capabilities of MRI, NIRS-IVUS, and their combination were compared. Results A total of 103 lesions from 103 patients (median age, 72 years [IQR, 64-78]; 78 male patients) were included. PMI occurred in 36 lesions. In multivariable analysis, PMR emerged as the strongest predictor (P = .001), whereas maxLCBI4 mm was not a significant predictor (P = .07). When PMR was excluded from the analysis, maxLCBI4 mm emerged as the sole independent predictor (P = .02). The combination of MRI and NIRS-IVUS yielded the largest area under the receiver operating curve (0.86 [95% CI: 0.64, 0.83]), surpassing that of NIRS-IVUS alone (0.75 [95% CI: 0.64, 0.83]; P = .02) or MRI alone (0.80 [95% CI: 0.68, 0.88]; P = .30). Conclusion Erythrocyte-derived materials in plaques, represented by a high PMR at CATCH MRI, were strongly associated with PMI independent of lipids. MRI may play a crucial role in predicting PMI by offering unique pathologic insights into plaques, distinct from those provided by NIRS. Keywords: Coronary Plaque, Periprocedural Myocardial Injury, MRI, Near-Infrared Spectroscopy Intravascular US Supplemental material is available for this article. © RSNA, 2024.
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Intervención Coronaria Percutánea , Placa Aterosclerótica , Espectroscopía Infrarroja Corta , Humanos , Masculino , Femenino , Espectroscopía Infrarroja Corta/métodos , Anciano , Placa Aterosclerótica/diagnóstico por imagen , Estudios Retrospectivos , Persona de Mediana Edad , Imagen por Resonancia Magnética/métodos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Valor Predictivo de las Pruebas , Ultrasonografía Intervencional/métodos , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/patología , Lesiones Cardíacas/diagnóstico por imagen , Lesiones Cardíacas/patologíaRESUMEN
This paper reports the case of a female patient who underwent minimally invasive repair of pectus excavatum (MIRPE) in another service that evolved with bar rotation and cardiac perforation caused by the left stabilizer. The unique and frightening aspect of the case is that despite having the stabilizer inside the ventricle, the patient was oligosymptomatic: occasional chest pain and respiratory discomfort. Preoperative imaging showed rotation of the bar with stabilizers within the thoracic cavity. During surgery, intense ossification was observed around the prosthesis and it was noted that the left stabilizer had perforated the patient's left ventricle. Cardiac repair required a Clamshell incision and cardiopulmonary bypass. This case reinforces the validity of late radiological follow-up after MIRPE in an attempt to avoid this type of event, and the need to reevaluate the use of stabilizers perpendicular to the bar since they are not safe to prevent rotation of these implants.
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Tórax en Embudo , Lesiones Cardíacas , Humanos , Tórax en Embudo/cirugía , Femenino , Lesiones Cardíacas/diagnóstico por imagen , Lesiones Cardíacas/etiología , Lesiones Cardíacas/cirugía , Ventrículos Cardíacos/lesiones , Ventrículos Cardíacos/diagnóstico por imagen , Procedimientos Quirúrgicos Mínimamente Invasivos/métodosAsunto(s)
Calcinosis , Válvula Mitral , Humanos , Calcinosis/diagnóstico por imagen , Calcinosis/fisiopatología , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/fisiopatología , Válvula Mitral/cirugía , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/fisiopatología , Enfermedades de las Válvulas Cardíacas/cirugía , Enfermedades de las Válvulas Cardíacas/complicaciones , Resultado del Tratamiento , Lesiones Cardíacas/diagnóstico por imagen , Lesiones Cardíacas/etiologíaRESUMEN
We present the case of a patient who was shot through the heart with an air rifle and presented in a stable condition at our emergency department. At the time of presentation, the bullet was still present within the myocardium. Imaging, management, and outcome are discussed in this report.
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Heridas por Arma de Fuego , Humanos , Heridas por Arma de Fuego/diagnóstico por imagen , Heridas por Arma de Fuego/complicaciones , Masculino , Lesiones Cardíacas/etiología , Lesiones Cardíacas/diagnóstico por imagen , AdultoAsunto(s)
Cateterismo Cardíaco , Anuloplastia de la Válvula Cardíaca , Implantación de Prótesis de Válvulas Cardíacas , Insuficiencia de la Válvula Tricúspide , Válvula Tricúspide , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Cateterismo Cardíaco/instrumentación , Cateterismo Cardíaco/efectos adversos , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/lesiones , Vasos Coronarios/cirugía , Lesiones Cardíacas/etiología , Lesiones Cardíacas/diagnóstico por imagen , Lesiones Cardíacas/terapia , Lesiones Cardíacas/cirugía , Prótesis Valvulares Cardíacas , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Válvula Tricúspide/cirugía , Válvula Tricúspide/diagnóstico por imagen , Válvula Tricúspide/fisiopatología , Insuficiencia de la Válvula Tricúspide/cirugía , Insuficiencia de la Válvula Tricúspide/diagnóstico por imagen , Insuficiencia de la Válvula Tricúspide/fisiopatología , Insuficiencia de la Válvula Tricúspide/etiología , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/etiología , Lesiones del Sistema Vascular/cirugíaAsunto(s)
Atrios Cardíacos , Marcapaso Artificial , Neumopericardio , Humanos , Neumopericardio/etiología , Neumopericardio/diagnóstico por imagen , Marcapaso Artificial/efectos adversos , Atrios Cardíacos/lesiones , Atrios Cardíacos/diagnóstico por imagen , Lesiones Cardíacas/etiología , Lesiones Cardíacas/diagnóstico por imagen , Pericardio/lesiones , Pleura/lesiones , Pleura/diagnóstico por imagen , Masculino , Anciano , Femenino , Factores de Tiempo , Electrodos Implantados/efectos adversosAsunto(s)
Lesiones Cardíacas , Marcapaso Artificial , Humanos , Marcapaso Artificial/efectos adversos , Lesiones Cardíacas/etiología , Lesiones Cardíacas/diagnóstico por imagen , Falla de Equipo , Masculino , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/complicaciones , Anciano , FemeninoRESUMEN
AIMS: To characterize the diagnosis, frequency, and procedural implications of septal venous channel perforation during left bundle branch area pacing (LBBAP). METHODS AND RESULTS: All consecutive patients undergoing LBBAP over an 8-month period were prospectively studied. During lead placement, obligatory septal contrast injection was performed twice, at initiation (implant entry zone) and at completion (fixation zone). An intuitive fluoroscopic schema using orthogonal views (left anterior oblique/right anterior oblique) and familiar landmarks is described. Using this, we resolved zonal distribution (I-VI) of lead position on the ventricular septum and its angulation (post-fixation angle θ). Subjects with and without septal venous channel perforation were compared. Sixty-one patients {male 57.3%, median age [interquartile range (IQR)] 69.5 [62.5-74.5] years} were enrolled. Septal venous channel perforation was observed in eight (13.1%) patients [male 28.5%, median age (IQR) 64 (50-75) years]. They had higher frequency of (i) right-sided implant (25% vs. 1.9%, P = 0.04), (ii) fixation in zone III at the mid-superior septum (75% vs. 28.3%, P = 0.04), (iii) steeper angle of fixation-median θ (IQR) [19 (10-30)° vs. 5 (4-19)°, P = 0.01], and (iv) longer median penetrated-lead length (IQR) [13 (10-14.8) vs. 10 (8.5-12.5) mm, P = 0.03]. Coronary sinus drainage of contrast was noted in five (62.5%) patients. Abnormal impedance drops during implantation (12.5% vs. 5.7%, P = NS) were not significantly different. CONCLUSION: When evaluated systematically, septal venous channel perforation may be encountered commonly after LBBAP. The fiducial reference framework described using fluoroscopic imaging identified salient associated findings. This may be addressed with lead repositioning to a more inferior location and is not associated with adverse consequence acutely or in early follow-up.
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Estimulación Cardíaca Artificial , Humanos , Masculino , Femenino , Estudios Prospectivos , Persona de Mediana Edad , Anciano , Estimulación Cardíaca Artificial/métodos , Tabique Interventricular/diagnóstico por imagen , Lesiones Cardíacas/etiología , Lesiones Cardíacas/diagnóstico por imagen , Resultado del Tratamiento , Factores de Riesgo , Fascículo Atrioventricular/fisiopatología , Tabiques Cardíacos/diagnóstico por imagen , Medios de Contraste , Fluoroscopía , Bloqueo de Rama/fisiopatología , Bloqueo de Rama/etiologíaAsunto(s)
Ablación por Catéter , Lesiones Cardíacas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fibrilación Atrial/cirugía , Fibrilación Atrial/fisiopatología , Ablación por Catéter/efectos adversos , Lesiones Cardíacas/etiología , Lesiones Cardíacas/diagnóstico por imagen , Lesiones Cardíacas/cirugía , Resultado del TratamientoRESUMEN
An 86-year-old female with history of surgical aortic valve replacement presented with clinical signs of heart failure. Echocardiography revealed a reduction in left ventricular systolic function and severe bioprosthetic aortic valve dysfunction. This is the first reported case of valve-in-valve transcatheter aortic valve replacement with concomitant undermining iatrogenic coronary obstruction with radiofrequency needle procedure in a surgical bioprosthetic valve.
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Estenosis de la Válvula Aórtica , Válvula Aórtica , Bioprótesis , Prótesis Valvulares Cardíacas , Enfermedad Iatrogénica , Diseño de Prótesis , Reemplazo de la Válvula Aórtica Transcatéter , Humanos , Anciano de 80 o más Años , Femenino , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Reemplazo de la Válvula Aórtica Transcatéter/instrumentación , Resultado del Tratamiento , Válvula Aórtica/cirugía , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/fisiopatología , Estenosis de la Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/fisiopatología , Ablación por Catéter/efectos adversos , Falla de Prótesis , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Lesiones Cardíacas/etiología , Lesiones Cardíacas/diagnóstico por imagen , Lesiones Cardíacas/terapia , Agujas , Función Ventricular Izquierda , Oclusión Coronaria/diagnóstico por imagen , Oclusión Coronaria/etiología , Oclusión Coronaria/terapia , Oclusión Coronaria/fisiopatología , Angiografía CoronariaRESUMEN
BACKGROUND: The extent of cardiac damage and its association with clinical outcomes in patients undergoing transcatheter edge-to-edge repair (TEER) for degenerative mitral regurgitation remains unclear. This study was aimed to investigate cardiac damage in patients with degenerative mitral regurgitation treated with TEER and its association with outcomes. METHODS: We analyzed patients with degenerative mitral regurgitation treated with TEER in the Optimized Catheter Valvular Intervention-Mitral registry, which is a prospective, multicenter observational data collection in Japan. The study subjects were classified according to the extent of cardiac damage at baseline: no extravalvular cardiac damage (stage 0), mild left ventricular or left atrial damage (stage 1), moderate left ventricular or left atrial damage (stage 2), or right heart damage (stage 3). Two-year mortality after TEER was compared using Kaplan-Meier analysis. RESULTS: Out of 579 study participants, 8 (1.4%) were classified as stage 0, 76 (13.1%) as stage 1, 319 (55.1%) as stage 2, and 176 (30.4%) as stage 3. Two-year survival was 100% in stage 0, 89.5% in stage 1, 78.9% in stage 2, and 75.3% in stage 3 (P=0.013). Compared with stage 0 to 1, stage 2 (hazard ratio, 3.34 [95% CI, 1.03-10.81]; P=0.044) and stage 3 (hazard ratio, 4.51 [95% CI, 1.37-14.85]; P=0.013) were associated with increased risk of 2-year mortality after TEER. Significant reductions in heart failure rehospitalization rate and New York Heart Association functional scale were observed following TEER (both, P<0.001), irrespective of the stage of cardiac damage. CONCLUSIONS: Advanced cardiac damage is associated with an increased risk of mortality in patients undergoing TEER for degenerative mitral regurgitation. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: UMIN000023653.
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Cateterismo Cardíaco , Implantación de Prótesis de Válvulas Cardíacas , Insuficiencia de la Válvula Mitral , Válvula Mitral , Sistema de Registros , Humanos , Insuficiencia de la Válvula Mitral/cirugía , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/mortalidad , Insuficiencia de la Válvula Mitral/fisiopatología , Masculino , Femenino , Anciano , Válvula Mitral/cirugía , Válvula Mitral/fisiopatología , Válvula Mitral/diagnóstico por imagen , Japón , Cateterismo Cardíaco/efectos adversos , Cateterismo Cardíaco/mortalidad , Resultado del Tratamiento , Factores de Tiempo , Estudios Prospectivos , Factores de Riesgo , Anciano de 80 o más Años , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/mortalidad , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Medición de Riesgo , Recuperación de la Función , Lesiones Cardíacas/mortalidad , Lesiones Cardíacas/etiología , Lesiones Cardíacas/terapia , Lesiones Cardíacas/diagnóstico por imagenAsunto(s)
Trasplante de Corazón , Donantes de Tejidos , Fístula Vascular , Humanos , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/etiología , Resultado del Tratamiento , Masculino , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/etiología , Lesiones del Sistema Vascular/cirugía , Lesiones del Sistema Vascular/terapia , Angiografía Coronaria , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/lesiones , Persona de Mediana Edad , Lesiones Cardíacas/etiología , Lesiones Cardíacas/diagnóstico por imagen , Lesiones Cardíacas/terapiaAsunto(s)
Remoción de Dispositivos , Válvula Tricúspide , Humanos , Desfibriladores Implantables , Remoción de Dispositivos/efectos adversos , Lesiones Cardíacas/etiología , Lesiones Cardíacas/diagnóstico por imagen , Lesiones Cardíacas/cirugía , Marcapaso Artificial/efectos adversos , Recuperación de la Función , Resultado del Tratamiento , Válvula Tricúspide/cirugía , Válvula Tricúspide/fisiopatología , Válvula Tricúspide/diagnóstico por imagen , Insuficiencia de la Válvula Tricúspide/cirugía , Insuficiencia de la Válvula Tricúspide/etiología , Insuficiencia de la Válvula Tricúspide/diagnóstico por imagen , Insuficiencia de la Válvula Tricúspide/fisiopatologíaRESUMEN
Penetrating cardiac injuries usually require emergent surgical intervention. Our patient presented to the trauma centre with multiple stab wounds to the neck, chest, epigastric region and abdomen. She arrived haemodynamically stable, and her initial Focused Assessment with Sonography for Trauma exam was negative. Her chest X-ray did not show any evident pneumothorax or haemothorax. Due to her injury pattern, she was taken to the operating room for exploratory laparotomy and neck exploration. Postoperatively, she was taken for CT and found to have a contained cardiac rupture. The injury was contained within previous scar tissue from her prior cardiac surgery. Further evaluation revealed that the injury included a penetrating stab wound to the right ventricle and a traumatic ventricular septal defect (VSD). She subsequently underwent a redo sternotomy with the repair of the penetrating stab wound and the VSD. Cardiology, intensive care, trauma surgery and cardiothoracic surgery coordinated her care from diagnosis, management and recovery. This case highlights the challenges in the management of cardiac injuries and the benefits of a multidisciplinary approach to care for complex cardiac injuries.
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Procedimientos Quirúrgicos Cardíacos , Lesiones Cardíacas , Heridas Penetrantes , Heridas Punzantes , Femenino , Humanos , Corazón , Lesiones Cardíacas/diagnóstico por imagen , Lesiones Cardíacas/etiología , Lesiones Cardíacas/cirugía , Heridas Penetrantes/complicaciones , Heridas Penetrantes/diagnóstico por imagen , Heridas Penetrantes/cirugía , Heridas Punzantes/complicaciones , Heridas Punzantes/cirugíaRESUMEN
BACKGROUND: The past decades have seen the rapid development of the invasive treatment of arrhythmias by catheter ablation procedures. Despite its safety and efficacy being well-established in adults, to date there has been little data in pediatric scenarios. One of the main concerns is the possible expansion of the ablation procedure scar in this population and its consequences over the years. OBJECTIVES: This study aimed to analyze the risk of myocardial injury progression after radiofrequency catheter ablation in pediatric patients. METHODS: This is a retrospective study of 20 pediatric patients with previous ablation for treatment of supraventricular arrhythmia that underwent cardiac magnetic resonance and coronary angiography for evaluation of myocardial fibrosis and the integrity of the coronary arteries during follow-up. RESULTS: The median age at ablation procedure was 15.1 years (Q1 12.9, Q3 16.6) and 21 years (Q1 20, Q3 23) when the cardiac magnetic resonance was performed. Fourteen of them were women. Nodal reentry tachycardia and Wolf-Parkinson-White Syndrome were the main diagnosis (19 patients), with one patient with atrial tachycardia. Three patients had ventricular myocardial fibrosis, but with a volume < 0.6 cm 3 . None of them developed ventricular dysfunction and no patient had coronary lesions on angiography. CONCLUSION: Radiofrequency catheter ablation did not show to increase the risk of myocardial injury progression or coronary artery lesions.
FUNDAMENTO: As últimas décadas têm assistido ao rápido desenvolvimento do tratamento invasivo de arritmias por procedimentos de ablação por cateter. Apesar da sua segurança e eficácia bem estabelecida em adultos, até o momento, há poucos dados nos cenários pediátricos. Uma das principais preocupações é a possível expansão da cicatriz do procedimento de ablação nessa população e suas consequências ao longo dos anos. OBJETIVOS: Este estudo teve como objetivo analisar o risco da progressão da lesão miocárdica após ablação por cateter de radiofrequência em pacientes pediátricos. MÉTODOS: Este é um estudo retrospectivo de 20 pacientes pediátricos com tratamento prévio de arritmia supraventricular com ablação, submetidos à ressonância magnética cardíaca e angiografia coronária para avaliação de fibrose miocárdica e da integridade das artérias coronárias durante o acompanhamento. RESULTADOS: A idade mediana no procedimento de ablação foi 15,1 anos (Q1 12,9, Q3 16,6) e 21 anos (Q1 20, Q3 23) quando a ressonância magnética cardíaca foi realizada. Quatorze dos pacientes eram mulheres. Taquicardia por reentrada nodal e síndrome de Wolf-Parkinson-White foram os principais diagnósticos (19 pacientes), com um paciente com taquicardia atrial. Três pacientes apresentaram fibrose miocárdica ventricular, mas com um volume inferior a 0,6 cm 3 . Nenhum deles desenvolveu disfunção ventricular e nenhum paciente apresentou lesões coronarianos na angiografia. CONCLUSÃO: A ablação por cateter de radiofrequência não mostrou aumentar o risco de progressão de lesão miocárdica ou de lesões na artéria coronária.
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Ablación por Catéter , Lesiones Cardíacas , Taquicardia Supraventricular , Adulto , Humanos , Niño , Femenino , Masculino , Estudios Retrospectivos , Taquicardia Supraventricular/cirugía , Arritmias Cardíacas , Nodo Atrioventricular , Ablación por Catéter/efectos adversos , Ablación por Catéter/métodos , Lesiones Cardíacas/diagnóstico por imagen , Lesiones Cardíacas/etiología , FibrosisRESUMEN
A woman in her 80s experienced a life-threatening complication of pacemaker implant consisting of subacute right ventricular lead perforation causing iatrogenic injury to an intercostal artery, resulting in a large haemothorax. A CT scan confirmed active bleeding from the fourth intercostal artery. The patient underwent cardiothoracic surgery via a median sternotomy approach, during which the source of the bleeding was sealed, a new epicardial lead was positioned, and the original lead was extracted. This case emphasises the potentially severe consequences of pacemaker lead perforation and secondary injury to adjacent structures. It underscores the importance of early recognition and timely intervention, preferably in a tertiary specialist unit equipped for cardiothoracic surgery and confirms the value of pacemaker interrogation and CT scans for diagnosis.
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Lesiones Cardíacas , Marcapaso Artificial , Femenino , Humanos , Arterias , Lesiones Cardíacas/diagnóstico por imagen , Lesiones Cardíacas/etiología , Lesiones Cardíacas/cirugía , Hemorragia/diagnóstico por imagen , Hemorragia/etiología , Hemorragia/terapia , Hemotórax/diagnóstico por imagen , Hemotórax/etiología , Hemotórax/cirugía , Enfermedad Iatrogénica , Marcapaso Artificial/efectos adversos , Anciano de 80 o más AñosRESUMEN
Cardiac diffusion weighted-magnetic resonance imaging (DWI) has slowly developed due to its technical difficulties. However, this limitation could be overcome by advanced techniques, including a stimulated echo technique and a gradient moment nulling technique. This study aimed to develop and validate a high-order DWI sequence, using echo-planar imaging (EPI) and second-order motion-compensated (M012) diffusion gradient applied to cardiac imaging in small-sized animals with fast heart and respiratory rates, and to investigate the feasibility of cardiac DWI, diagnosing acute myocardial injury in isoproterenol-induced myocardial injury rat models. The M012 diffusion gradient sequence was designed for diffusion tensor imaging of the rat myocardium and validated in the polyvinylpyrrolidone phantom. Following sequence optimization, 23 rats with isoproterenol-induced acute myocardial injury and five healthy control rats underwent cardiac MRI, including cine imaging, T1 mapping, and DWI. Diffusion gradient was applied using a 9.4-T MRI scanner (Bruker, BioSpec 94/20, gradient amplitude = 440 mT/m, maximum slew rate = 3440 T/m/s) with double gating (electrocardiogram and respiratory gating). Troponin I was used as a serum biomarker for myocardial injury. Histopathologic examination of the heart was subsequently performed. The developed DWI sequence using EPI and M012 provided the interpretable images of rat hearts. The apparent diffusion coefficient (ADC) values were significantly higher in rats with acute myocardial injury than in the control group (1.847 ± 0.326 * 10-3 mm2/s vs. 1.578 ± 0.144 * 10-3 mm2/s, P < 0.001). Troponin I levels were increased in the blood samples of rats with acute myocardial injury (P < 0.001). Histopathologic examinations detected myocardial damage and subendocardial fibrosis in rats with acute myocardial injury. The newly developed DWI technique has the ability to detect myocardial injury in small animal models, representing high ADC values on the myocardium with isoproterenol-induced injury.
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Imagen de Difusión Tensora , Lesiones Cardíacas , Animales , Ratas , Troponina I , Isoproterenol , Imagen de Difusión por Resonancia Magnética/métodos , Imagen por Resonancia Magnética/métodos , Lesiones Cardíacas/inducido químicamente , Lesiones Cardíacas/diagnóstico por imagen , Modelos Animales , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: Although chest trauma happens very often, accompanying tricuspid valve injuries occur rarely and may be manifested by scarce symptoms and signs. Pericardial rupture with cardiac herniation is even a bigger rarity. Transthoracic echocardiography plays a key role in the diagnosis of valve injuries but is of limited value in cardiac herniation. CASE PRESENTATION: We present the case of 58-year-old man who experienced severe chest trauma in a car accident. Symptoms of right heart failure occurred 10 years after the injury, due to the loss of tricuspid leaflet support caused by the rupture of tendinous chords with significant tricuspid regurgitation. Intraoperatively, old posttraumatic pericardial rupture into left pleura was also found, with partial cardiac herniation and pressure of the edge of pericardium on all left-sided coronary arteries simultaneously. The patient was successfully operated and is free of symptoms 4 years later. CONCLUSIONS: This case emphasizes the importance of timely diagnosis and underlines a mechanism that leads to delayed rupture of the tricuspid valve apparatus. Repeated echocardiography in all patients who experienced chest trauma could be of great importance. Also, given the limited value of echocardiography in posttraumatic pericardial rupture and cardiac herniation, cardiac computed tomography should be performed.