Cardiac contusion following blunt chest trauma is not rare, and the works in the literature report incidence rates between 5 and 50%. Traffic accidents are the most frequent cause of cardiac contusion followed by violent fall impacts, aggressions and the practice of risky sports. The spectrum of post-traumatic cardiac lesions varies greatly, ranging from no symptoms to decrease in cardiac function. Cardiogenic shock is a rarely encountered manifestation of blunt cardiac contusion. We review our experience of cardiac contusion after blunt chest trauma, and we describe two very severe cases that manifested as cardiogenic shock. We emphasize an early diagnosis by continuous electrocardiographic monitoring, serial electrocardiograms, echocardiography, serum determination of biochemical cardiac markers, radionuclide imaging and coronary angiography. The treatment includes continuous monitoring of cardiac rhythm, use of inotropic drugs, insertion of a catheter in the pulmonary artery for continuous assessment of cardiac output and, in extreme cases, the insertion of a contrapulsation balloon to maintain haemodynamics until improvement of cardiac function.
True aneurysm formation in arterialized autologous veins is an unusual complication. A saccular aneurysmal degeneration of 53 mm (maximal diameter) of a saphenous vein graft inserted for repair of a popliteal aneurysm, four years after implantation, is reported. The patient (with prior history of abdominal aortic aneurysm) had been initially treated through a posterior approach. A new saphenous vein bypass grafting (medial approach) was performed. Histological examination revealed myointimal fibrosis, medial degeneration and inflammation. In spite of the widespread use of the autologous saphenous vein as an arterial substitute, this complication is extremely rare and its etiology remains unclear. Atherosclerosis is considered to be the main cause of aneurysm formation in vein grafts, but current data suggest that additional etiopathogenic factors should be further investigated. We note the rarity of this finding and review the literature for true aneurysm formation within vein grafts used for bypass procedures.
About 2% of all paragangliomas are located in the chest, and a few have been described to be found in the heart. Primary cardiac paragangliomas are extremely uncommon tumors and surgical experience with this neoplasm is limited. Treatment strategies described in the literature have included simple excision, excision with reconstruction, autotransplantation after excision of the tumor and even orthotopic cardiac transplantation, depending on the extent of disease. A primary retrocardiac paraganglioma catecholamine-productive was identified in an asymptomatic 49–year old female associated to familial pheochromocytoma-paraganglioma syndrome caused by germline mutation of the gen which codifies for the subunit B of succinate dehydrogenase enzyme (SDHB). The neoplasm was surgically excised from the posterior surface of the left atrium via median sternotomy using cardiopulmonary bypass. Direct ligation of feeding vessels of the tumor along with left atrial reinforcement using a pericardial patch was performed. The post-operative course was uneventful, with normalization of catecholamine secretion and no recurrence at three-month follow-up. We review the current literature about this exceptional cardiac tumor, pathophysiological conditions and options for surgical management.
A four-month-old infant with anomalous origin of the left coronary artery from the pulmonary artery developed severe left ventricular failure after aortic reimplantation, despite prolonged supportive cardiopulmonary bypass with high level inotropic support and several abortive attempts for discontinuation. The Batista procedure was performed and the patient was successfully weaned from bypass. Postoperative recovery was uneventful, and at one-year follow-up she remains asymptomatic.
An optimal preoperative evaluation is fundamental to the assessment of all patients undergoing cardiac surgery. We report the case of a male patient who underwent elective coronary artery bypass surgery, and intraoperative transesophageal echocardiography (TEE) revealed an unexpected left atrial cavernous hemangioma. The tumor was resected via a transatrial approach, and a definitive diagnosis was made after histological examination. This uncommon intra-atrial tumor (which accounts for approximately 2.8% of all benign cardiac neoplasms) was detected at the time of the operation as no basic echocardiography study had been performed on the patient during the process of diagnosing his coronary heart disease because of a suboptimal cardiological work-up. Most cardiac masses are discovered incidentally by imaging techniques; in this patient, transthoracic echocardiography could have aided in the preoperative study and enabled the cardiac surgeon to plan and perform the adequate surgical procedure beforehand. Intraoperative TEE should be used routinely in all patients undergoing cardiac surgery: the clinical information obtained in certain cases might have a direct impact on surgical decision-making and might therefore positively influence patient's outcome.
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