RESUMO
The case of a 45-year-old man with severe tricuspid insufficiency and interatrial septum rupture caused by a car accident is described. The patient had a rupture of the anterior papillary muscle of the tricuspid valve and right-to-left shunt through an interatrial defect with severe hypoxemia that was difficult to distinguish from that caused by pulmonary damage. Transesophageal echocardiography was extremely useful for early diagnosis.
Assuntos
Traumatismos Cardíacos/complicações , Hipóxia/etiologia , Insuficiência da Valva Tricúspide/etiologia , Ferimentos não Penetrantes/complicações , Ecocardiografia Transesofagiana , Traumatismos Cardíacos/diagnóstico por imagem , Septos Cardíacos/diagnóstico por imagem , Septos Cardíacos/lesões , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Ferimentos não Penetrantes/diagnóstico por imagemRESUMO
A case of delayed papillary muscle rupture is reported, which developed 24 hours following a mild chest trauma. Transthoracic echocardiography established the diagnosis; immediate mitral valve replacement was carried out. The postoperative course was uneventful.
Assuntos
Traumatismos Cardíacos/diagnóstico , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral/etiologia , Acidentes por Quedas , Adolescente , Cardiomiopatias/etiologia , Traumatismos Cardíacos/complicações , Traumatismos Cardíacos/cirurgia , Humanos , Masculino , Valva Mitral , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/cirurgia , Músculos Papilares/lesões , Ruptura , Ferimentos não Penetrantes/complicaçõesRESUMO
Thirteen patients with ages between 53 and 74 years had development of free wall left ventricular rupture after a myocardial infarction (mean interval, 3.8 days). All patients showed clinical signs of cardiac tamponade. Diagnosis was established by bedside multiple pressure monitoring and echocardiography, which showed pericardial effusion with compression of the right ventricle. Cardiac catheterization was not performed. A new surgical technique was employed for the repair. After the pericardium was opened and cardiac tamponade was relieved, the myocardial tear was identified. A Teflon patch was applied over the area and glued to the heart surface with a surgical glue (cyanoacrylate). Cardiopulmonary bypass was not used except in a patient with a posterior tear. The method was consistently effective in controlling bleeding from the myocardial tear. All patients survived the operation and were discharged from the hospital a mean of 15 days after the operation. Follow-up extending up to 5 years (mean, 26 months) shows a 100% survival, 11 asymptomatic patients, and 2 patients with mild exertional angina. The technique is a simple, effective, and safe method for repair of subacute cardiac rupture and obviates the need for suturing on an infarcted ventricle.
Assuntos
Prótese Vascular , Embucrilato/uso terapêutico , Ruptura Cardíaca Pós-Infarto/cirurgia , Hemodinâmica/fisiologia , Complicações Pós-Operatórias/fisiopatologia , Idoso , Feminino , Ruptura Cardíaca Pós-Infarto/mortalidade , Ruptura Cardíaca Pós-Infarto/fisiopatologia , Ventrículos do Coração/fisiopatologia , Ventrículos do Coração/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Contração Miocárdica/fisiologia , Complicações Pós-Operatórias/mortalidade , Cicatrização/fisiologiaRESUMO
Percutaneous mitral valvuloplasty is actually accepted as alternative to surgery for treatment of rheumatic mitral stenosis, although today it is not still free from troublesome complications like ventricular perforation. We present here a patient in which was performed a percutaneous mitral valvuloplasty and that developed a left ventricular perforation at the end of the procedure, with hyperacute cardiac tamponade, requiring an in situ surgical salvagement on an emergency basis, performing a successful repair of the ventricular rupture in the own catheterization laboratory.