A case of right coronary artery occlusion, caused by blunt chest trauma and treated with acute coronary artery bypass surgery

Gustavsson, Carl Gunnar; Albrechtsson, U.; Forslind, Kristina; Stahl, Eric; White, Thomas E.

doi:10.1093/oxfordjournals.eurheartj.a060033

Cited by 14 publications

(9 citation statements)

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“…In the setting of blunt trauma, injury to the aortic valve, left main bronchus, or a coronary artery has been identified. [13][14][15] CABG has been performed in the setting of injury to one or more of the coronary arteries, but all of these patients required a bypass procedure for acute injuries. 15,16 In contrast, traumatic rupture of a normal aorta accompanied by CABG for a chronic disease process such as coronary artery disease does not appear to have been previously reported.…”

Section: Discussionmentioning

confidence: 99%

“…[13][14][15] CABG has been performed in the setting of injury to one or more of the coronary arteries, but all of these patients required a bypass procedure for acute injuries. 15,16 In contrast, traumatic rupture of a normal aorta accompanied by CABG for a chronic disease process such as coronary artery disease does not appear to have been previously reported. In this instance, although relatively young without a known past medical history, the patient's heart function was clearly depressed intraoperatively as documented by TEE, and chronic disease was evident by grossly visible calcifications of the left anterior and posterior descending coronary arteries.…”

Section: Discussionmentioning

confidence: 99%

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CABG for Chronic Disease During Repair of Traumatic Ascending Aortic Rupture

Hartwig

Biswas

Glower

et al. 2005

The Journal of Trauma: Injury, Infection, and Critical Care

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T raumatic rupture of the thoracic aorta is a well-described phenomenon involving significant morbidity and mortality. Classically, this injury occurs at the aortic isthmus, where the aorta is tethered by ligamentous fibers. Although less common, several cases of ascending aortic rupture have been documented in the literature. Here we report a case of traumatic ascending aortic injury requiring emergent surgical repair. At the time of the procedure, the patient was noted to have severely calcified coronary arteries with evidence of previous myocardial damage and decreased ventricular function. Coronary artery bypass grafting (CABG) concomitant with placement of the aortic transposition graft was performed. CASE REPORTA 45-year-old Native American male lost control of his motorcycle at high speed and was ejected over 20 feet. He lost consciousness initially, but was taken to the local hospital where he was oriented on arrival and was noted to have an acetabular fracture and several rib fractures.He underwent intubation and fluid resuscitation and was airlifted to the regional level I trauma center for further evaluation. Vital signs on admission were a heart rate of 108 bpm and blood pressure of 135/81 mm Hg. AP portable CXR demonstrated right rib fractures, clavicle fracture, pulmonary contusion, enlarged cardiac silhouette, and a widened superior mediastinum (Fig. 1).CT scans of the head, abdomen, and pelvis were normal, except for a complex acetabular fracture. CT scan of the chest showed multiple displaced right rib fractures with a hemopneumothorax, pulmonary contusion, left scapula fracture, L 1 compression fracture, and a contour abnormality in the ascending aorta (Fig. 2) concerning for traumatic aortic injury. The descending aorta appeared intact. Arch aortogram demonstrated a 1 cm flap approximately 2 cm distal to the aortic valve consistent with traumatic aortic injury (Fig. 3).The patient underwent emergent repair of the aortic transection.Repair of the ascending aortic injury consisted of placing the patient on cardiopulmonary bypass (CPB) with cannulation of the aortic arch and the right atrium. The transection was identified approximately 1 cm distal to the left main

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

CABG for Chronic Disease During Repair of Traumatic Ascending Aortic Rupture

Hartwig

Biswas

Glower

et al. 2005

The Journal of Trauma: Injury, Infection, and Critical Care

View full text Add to dashboard Cite

show abstract

“…Myocardial infarction secondary to chest trauma is usually due to coronary thrombosis, coronary dissection or, even more rarely, external compression of the lumen by haemorrhage [3]. Coronary artery dissection secondary to chest trauma is very uncommon, and it is even more rare when it affects the right coronary artery [3][4][5][6][7]. We report a patient with a proximal right coronary artery dissection secondary to chest trauma that was successfully treated with coronary stenting.…”

mentioning

confidence: 99%

“…The subsequent clinical course was uneventful, and creatine-phosphokinase peak value was 3900 IU. Transthoracic and transoesophageal echocardiography ruled out aortic dissection.Coronary dissection after chest trauma most often affects the left coronary artery [4], but right coronary artery dissection has also been described [5][6][7]. Coronary dissection in this setting could be due to the impact and deceleration in horizontal and cranial directions, as it occurs in the case of aortic dissection secondary to chest trauma [8].…”

mentioning

confidence: 99%