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1.
Am Surg ; 85(11): 1205-1208, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31775959

RESUMO

Our department has a database of thoracic gunshot wounds (GSWs), which has cataloged these injury patterns over the past five decades. Prevailing wisdom on the management of these injuries suggested operative treatment beyond tube thoracostomy is not commonly required. It was our clinical impression that the operative treatment required beyond chest tube placement has greatly increased over the past several decades, whereas the operative management of cardiac GSWs seemed to be increasingly infrequent events. To test these observations, we analyzed the treatment of GSWs to the chest and heart in four distinct time periods, categorized as "historical" (1973-1975 and 1988-1990) and "modern" (2005-2007 and 2015-2017). There was a significant increase in emergent thoracotomy, delayed thoracic operations, overall operative interventions, and pulmonary resections from the historical period to the modern era. There was a decline in cardiac injuries treated, whereas the number of injuries remained constant. Mortality was unchanged between the early and later periods. Operative treatment beyond tube thoracostomy was much more prevalent for noncardiac thoracic GSWs in the past two decades than in the prior decades, whereas the number of cardiac wounds treated decreased by half.


Assuntos
Traumatismos Torácicos/cirurgia , Ferimentos por Arma de Fogo/cirurgia , Emergências , Traumatismos Cardíacos/epidemiologia , Traumatismos Cardíacos/mortalidade , Traumatismos Cardíacos/cirurgia , Humanos , Kentucky/epidemiologia , Pulmão/cirurgia , Traumatismos Torácicos/epidemiologia , Traumatismos Torácicos/mortalidade , Toracostomia/métodos , Toracotomia/estatística & dados numéricos , Toracotomia/tendências , Fatores de Tempo , Tempo para o Tratamento , Ferimentos por Arma de Fogo/epidemiologia , Ferimentos por Arma de Fogo/mortalidade
2.
J Cardiothorac Surg ; 14(1): 185, 2019 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-31684992

RESUMO

BACKGROUND: Cardiac radiofrequency ablation is a popular treatment for arrhythmias. However, it does have some complications, some of which are severe, even fatally. And there were limited reports on cardiac internal perforation after radiofrequency catheter ablation (RFCA) that required a surgical repair. CASE PRESENTATION: A 47-year-old male was admitted to our hospital due to chest congestion for 4 months. He received a radiofrequency catheter ablation (RFCA) 9 months prior to admission. On admission, an echocardiogram showed an abnormal perforation between the left ventricle and the left atrium with moderate mitral valve regurgitation. We therefore performed a mitral valve replacement (MVR) and fixed the abnormal atrial-ventricular breakage via median sternotomy. CONCLUSIONS: Cardiac perforation is a severe complication of cardiac RFCA, operators should be extremely cautious to minimize radiofrequency associated perforations. Such a challenging and complex procedure should be deliberately considered by doctors and patients before implementation.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Traumatismos Cardíacos/diagnóstico , Ecocardiografia , Átrios do Coração/lesões , Traumatismos Cardíacos/diagnóstico por imagem , Traumatismos Cardíacos/cirurgia , Implante de Prótese de Valva Cardíaca , Ventrículos do Coração/lesões , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral , Complicações Pós-Operatórias
4.
Rev Col Bras Cir ; 46(3): e20192154, 2019 Jul 10.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31291433

RESUMO

OBJECTIVE: to determine if computed tomography represents a safe option for penetrating heart injury screening. METHODS: retrospective transversal study which confronted tomographic findings with the ones detected in surgical exploration in patients that had undergone surgery because of suspected cardiac trauma from January, 2016 to January, 2018. RESULTS: seventy-two cases were analysed; 97.2% of them were males, and the most prevalent age range was 20 to 29 years; 56.9% of them presented injuries caused by firearm shots and 43.1% by cutting weapons. In 20 cases, computed tomography suggested heart injury, confirmed in 13 cases during surgery. Sensitivity of computed tomography was 56.5%, reaching a specificity of 85.7%. CONCLUSION: computed tomography must not be adopted as a routine for the screening of penetrating heart injuries.


Assuntos
Traumatismos Cardíacos/diagnóstico por imagem , Ferimentos Penetrantes/diagnóstico por imagem , Adulto , Estudos Transversais , Feminino , Traumatismos Cardíacos/classificação , Traumatismos Cardíacos/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X , Ferimentos Penetrantes/cirurgia , Adulto Jovem
5.
Rev Bras Ter Intensiva ; 31(2): 262-265, 2019 May 30.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31166560

RESUMO

Cardiac trauma often occurs in motor vehicle accidents. A 50-year-old female driver was transported to our hospital with multiple trauma after a high-speed car accident. After admission to the intensive care unit, cardiac ultrasound examination revealed traumatic tricuspid valve papillary muscle rupture and patent foramen ovale, while Lancisi's sign was noted on physical examination. Surgical treatment was performed with valve annuloplasty and closure of the patent foramen ovale and a covert right atrial defect that was detected intraoperatively.


Assuntos
Forame Oval Patente/etiologia , Átrios do Coração/cirurgia , Músculos Papilares/lesões , Valva Tricúspide/lesões , Acidentes de Trânsito , Anuloplastia da Valva Cardíaca/métodos , Feminino , Forame Oval Patente/diagnóstico , Forame Oval Patente/cirurgia , Átrios do Coração/lesões , Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/cirurgia , Humanos , Pessoa de Meia-Idade , Músculos Papilares/cirurgia , Valva Tricúspide/cirurgia
6.
J Card Surg ; 34(7): 632-634, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31212380

RESUMO

OBJECTIVES: Administration of heparin is standard in coronary artery bypass grafting (CABG) with or without cardiopulmonary bypass (OPCABG). In some circumstances, the risk of heparinization may outweigh its benefits, and there is scarce literature on how to proceed in these cases. We describe the technique used for OPCABG without heparin. METHODS: We report the case of a patient with a gunshot wound to the chest resulting in multiple lung lacerations and transection of the proximal left anterior descending coronary artery (LAD) leading to hemorrhagic shock with tamponade, and cardiogenic shock due to myocardial ischemia who received OPCABG without heparin. RESULTS: A 23-year-old patient suffered multiple gunshot wounds to the chest and was admitted in shock with massive left hemothorax. Emergency left thoracotomy revealed multiple lung lacerations and transection of the proximal left anterior coronary artery. The patient presented acute myocardial ischemia and progressed to cardiogenic shock requiring insertion of intra-aortic balloon pump (IABP) to try to support hemodynamics. OPCABG with a segment of reversed saphenous vein graft to the LAD coronary artery was performed using standard techniques but without heparinization. The graft was flushed with normal saline before completing both anastomosis. Myocardial ischemic changes reversed, and the patient stabilized immediately after completing OPCABG, allowing to wean off IABP in the operating room. Postoperative recovery was unremarkable, and the patient was discharged home on postoperative day 9. CONCLUSION: Benefits of OPCABG include decreased bleeding and lower requirement of blood transfusions. This experience shows that OPCABG can be performed without systemic heparinization in selected cases.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Vasos Coronários/lesões , Vasos Coronários/cirurgia , Traumatismos Cardíacos/cirurgia , Traumatismos Torácicos/cirurgia , Ferimentos por Arma de Fogo/cirurgia , Adulto , Traumatismos Cardíacos/complicações , Heparina , Humanos , Balão Intra-Aórtico , Masculino , Choque Cardiogênico/etiologia , Choque Cardiogênico/terapia , Traumatismos Torácicos/complicações , Resultado do Tratamento , Ferimentos por Arma de Fogo/complicações , Adulto Jovem
9.
Kyobu Geka ; 72(3): 228-231, 2019 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-30923301

RESUMO

Blunt chest trauma can cause life-threatening condition. We performed prompt drainage and operative repair for traumatic cardiac injury caused by striking at epigastric fossa. Close monitoring should be needed even for blunt chest trauma due to assault.


Assuntos
Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/cirurgia , Traumatismos Torácicos/complicações , Ferimentos não Penetrantes/complicações , Drenagem , Humanos
10.
Zhonghua Wai Ke Za Zhi ; 57(2): 134-138, 2019 Feb 01.
Artigo em Chinês | MEDLINE | ID: mdl-30704218

RESUMO

Objective: To investigate the indication and midterm outcomes of surgical treatment of traumatic tricuspid insufficiency. Methods: Totally 19 patients with traumatic tricuspid insufficiency who underwent surgical treatment at Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University from January 2002 to January 2018 were included in this retrospective study. There were 12 male and 7 female patients, aged (43.1±12.9) years (range: 17-68 years). The main causes of traumatic tricuspid insufficiency included blunt chest trauma following high-speed vehicle accidents (17 patients) and high-fall trauma (2 patients). The preoperative New York Heart Association functional class was class Ⅱ in 5 patients, class Ⅲ in 12 patients, and class Ⅳ in 2 patients. The mechanism of tricuspid insufficiency included anterior chordal rupture in 9 patients, anterior papillary muscle rupture in 3 patients, anterior and posterior chordal or papillary muscle rupture in 4 patients, laceration of leaflet combined with chordal rupture in 2 patients and infection combined with anterior papillary muscle rupture in 1 patient. Anular dilation and enlargement of the right ventricle were observed in all the patients. Paired t test was used to evaluate the echocardiogratic results at preoperation, postoperation and follow-up. Independent sample rank sum test was used to evaluate the intervals between trauma and surgery in tricuspid valve repair group and tricuspid valve replacement group. Results: Tricuspid valve repair was successful in 8 patients, and 11 patients underwent valve replacement. Among the patients who underwent valve replacement, 6 patients received mechanical valve and 5 received bioprosthetic valve. The interval from trauma to surgery of the valve repair group and valve replacement group were 8.5(10.0) months (range: 0.1-13.0 months) and 72.0 (108.0) months (range: 2.0-228.0 months), respectively. Concomitant procedures included debridement in scalp trauma (1 patient), internal fixation of femoral fracture (1 patient). One patient died from liver failure 10 days after operation and the remaining patients survived. Eighteen patients were followed up for (94±50) months, 15 patients were in New York Heart Association functional class Ⅰ and 3 patients in class Ⅱ. One patient received redo-tricuspid valve replacement because of mechanical valve failure at the 11 years of follow-up. Conclusions: The midterm outcomes of surgical treatment of severe traumatic tricuspid insufficiency were satisfactory. Early diagnosis and surgical invention were recommended to achieve successful valve repair.


Assuntos
Traumatismos Cardíacos/cirurgia , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/cirurgia , Ferimentos não Penetrantes/cirurgia , Adolescente , Adulto , Idoso , Procedimentos Cirúrgicos Cardíacos/métodos , Feminino , Seguimentos , Traumatismos Cardíacos/etiologia , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Resultado do Tratamento , Valva Tricúspide/lesões , Insuficiência da Valva Tricúspide/etiologia , Ferimentos não Penetrantes/complicações , Adulto Jovem
11.
Interact Cardiovasc Thorac Surg ; 28(6): 999-1000, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-30508174

RESUMO

The isolated coronary sinus (CS) rupture causing cardiac tamponade following blunt chest trauma is a very rare and very unique traumatic form of cardiac tamponade. Prompt recognition of this injury is crucial for patient survival. CS injuries are frequently difficult to repair and are potentially lethal. A meticulous repair carried out on an arrested, empty and well-protected heart is recommended to achieve secure haemostasis and CS patency. To our knowledge, this is the first report on the successful repair of isolated CS rupture following blunt chest trauma.


Assuntos
Tamponamento Cardíaco/etiologia , Seio Coronário/lesões , Traumatismos Cardíacos/complicações , Traumatismos Torácicos/complicações , Ferimentos não Penetrantes/complicações , Acidentes de Trânsito , Idoso , Procedimentos Cirúrgicos Cardíacos/métodos , Tamponamento Cardíaco/diagnóstico , Tamponamento Cardíaco/cirurgia , Seio Coronário/diagnóstico por imagem , Seio Coronário/cirurgia , Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/cirurgia , Humanos , Imagem Tridimensional , Masculino , Tomografia Computadorizada Multidetectores , Ruptura , Traumatismos Torácicos/diagnóstico , Ferimentos não Penetrantes/diagnóstico
12.
Clin Res Cardiol ; 108(5): 465-467, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30259106

RESUMO

Late perforation of the atrial wall after pacemaker implantation frequently remains asymptomatic but may cause chest pain, dyspnea or syncope. Perforation can also lead to rarer complications such as hemoptysis and pneumopericardium. We present the case of a patient who developed progressive hemoptysis 3 years after a dual-chamber pacemaker implantation. Pacemaker interrogation showed stable impedance of the right atrial lead and stable pacing threshold values. CT revealed perforation of the right atrial wall by the RA-lead with consecutive pneumopericardium and diffuse lung bleeding of the right middle lobe. The patient was hemodynamically stable at all times. The right atrial lead was transvenously extracted and replaced without any further complications.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Remoção de Dispositivo/métodos , Átrios do Coração/lesões , Traumatismos Cardíacos/complicações , Hemoptise/etiologia , Marca-Passo Artificial/efeitos adversos , Pneumopericárdio/etiologia , Idoso de 80 Anos ou mais , Bloqueio Atrioventricular/terapia , Ecocardiografia , Feminino , Seguimentos , Átrios do Coração/diagnóstico por imagem , Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/cirurgia , Hemoptise/diagnóstico , Humanos , Pneumopericárdio/diagnóstico , Fatores de Tempo , Tomografia Computadorizada por Raios X
13.
J Emerg Med ; 56(2): 197-200, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30389284

RESUMO

BACKGROUND: Injuries from nail guns are a unique type of penetrating trauma seen in emergency departments (EDs), rising in prevalence in the United States. These devices can lead to life-threatening injuries that require rapid diagnosis to help guide management. CASE REPORT: An elderly man was brought to the ED having sustained a nail gun injury to the chest. After loss of pulses, brief closed chest compressions and rapid blood product administration led to a return of spontaneous circulation. Using bedside ultrasound, a metallic foreign body was identified tracking through the right ventricle with associated pericardial fluid and pericardial clot. This rapid diagnosis with bedside ultrasound helped facilitate timely transport to the operating room for median sternotomy, foreign body removal, and pledgeted cardiac repair. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: With continued developments in image quality and acquisition, and improvements of physician operator performance, ultrasonography has continued to make significant impacts in traumatically injured patients in new ways. We present this case report to highlight precordial nail gun injuries and to emphasize the diagnostic capabilities of bedside ultrasound for these patients.


Assuntos
Traumatismos Cardíacos/cirurgia , Coração/fisiopatologia , Testes Imediatos/normas , Ultrassonografia/métodos , Ferimentos Penetrantes/diagnóstico , Idoso , Serviço Hospitalar de Emergência/organização & administração , Armas de Fogo/estatística & dados numéricos , Corpos Estranhos/complicações , Corpos Estranhos/cirurgia , Coração/diagnóstico por imagem , Traumatismos Cardíacos/etiologia , Humanos , Masculino , Testes Imediatos/tendências , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/cirurgia , Toracotomia/métodos , Ferimentos Penetrantes/cirurgia
17.
PLoS One ; 13(11): e0206744, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30408050

RESUMO

PURPOSE: Chordae rupture is one of the main lesions observed in traumatic heart events that might lead to severe tricuspid valve (TV) regurgitation. TV regurgitation following chordae rupture is often well tolerated with few or no symptoms for most patients. However, early repair of the TV is of great importance, as it might prevent further exacerbation of the regurgitation due to remodeling responses. To understand how TV regurgitation develops following this acute event, we investigated the changes on TV geometry, mechanics, and function of ex-vivo porcine hearts following chordae rupture. METHODS: Sonomicrometry techniques were employed in an ex-vivo heart apparatus to identify how the annulus geometry alters throughout the cardiac cycle after chordae rupture, leading to the development of TV regurgitation. RESULTS: We observed that the TV annulus significantly dilated (~9% in area) immediately after chordae rupture. The annulus area and circumference ranged from 11.4 ± 2.8 to 13.3 ± 2.9 cm2 and from 12.5 ± 1.5 to 13.5 ± 1.3 cm, respectively, during the cardiac cycle for the intact heart. After chordae rupture, the annulus area and circumference were larger and ranged from 12.3 ± 3.0 to 14.4 ± 2.9 cm2 and from 13.0 ± 1.5 to 14.0 ± 1.2 cm, respectively. CONCLUSIONS: In our ex-vivo study, we showed for the first time that the TV annulus dilates immediately after chordae rupture. Consequently, secondary TV regurgitation may be developed because of such changes in the annulus geometry. In addition, the TV leaflet and the right ventricle myocardium are subjected to a different mechanical environment, potentially causing further negative remodeling responses and exacerbating the detrimental outcomes of chordae rupture.


Assuntos
Cordas Tendinosas/lesões , Traumatismos Cardíacos/patologia , Insuficiência da Valva Tricúspide/etiologia , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/lesões , Animais , Fenômenos Biomecânicos , Cordas Tendinosas/fisiopatologia , Cordas Tendinosas/cirurgia , Dilatação , Modelos Animais de Doenças , Traumatismos Cardíacos/fisiopatologia , Traumatismos Cardíacos/cirurgia , Hemodinâmica , Técnicas In Vitro , Modelos Cardiovasculares , Sus scrofa , Valva Tricúspide/fisiopatologia , Valva Tricúspide/cirurgia , Insuficiência da Valva Tricúspide/fisiopatologia
19.
Acta Chir Orthop Traumatol Cech ; 85(2): 144-148, 2018.
Artigo em Tcheco | MEDLINE | ID: mdl-30295602

RESUMO

PURPOSE OF THE STUDY Outcome analysis of penetrating cardiac and great vessels injury within the 15-year existence of the cardiac surgery service as a part of the major trauma centre of the University Hospital Olomouc MATERIAL AND METHODS Retrospective analysis of a group of a total of 16 patients who underwent a surgery for penetrating cardiac and great vessels injury since II/2002 to XI/2016. The dominant causes of penetrating trauma were stab injuries (15 patients, 94%), in one patient only (6%) it was a gunshot injury. The mean age of the patients included in the group was 42.9 ± 16.1 years, with men significantly prevailing (13 patients, 81%). A total of 7 injured persons (44%) were haemodynamically stable when admitted, 9 injured persons (56%) were unstable or in critical condition. The average transfer distance was 48.8 ± 34.5 km; the injured were admitted on average 115.9 ± 154.8 minutes after being injured. Preoperatively, all the injured suffered from pericardial effusion (>5 mm) confirmed by TTE (81%) or CTA (19%). In 4 patients (25%) pericardial drainage for cardiac tamponade was performed before surgery. RESULTS All the penetrating cardiac and great vessels injuries were repaired by cardiac surgeon, in one case only (6%) the extracorporeal circulation support was used. The injury of coronary arteries was in one case managed by CABG and in the other case by ligation of the peripheral part of the coronary artery. In 4 patients (25%) also a penetrating injury of other organs was simultaneously managed. The mean ICU stay reached 85.8 ± 91.9 hours, on average 5.6 ± 9.3 units of red blood cells were administered during the in-hospital stay which lasted on average 7.1 ± 2.4 days. In the group a nonsignificant increase of left ventricular ejection fraction (44.1 ± 4.7 vs. 49.3 ± 3.2, p = 0.882) was reported at discharge of the injured patients. One patient died on the 78 th day of hypoxic brain damage (6% three-month mortality). The long-term survival analysis showed 94% one-year and 88% five-year cumulative survival in the group. DISCUSSION The incidence of the penetrating cardiac and great vessels injury is directly dependent on the crime level in the respective countries and regions. A cardiac arrest, severe hemodynamic instability, unconsciousness, serious concomitant injury, gunshot injury, multiple or atrial injury represent independent predictors of death in these injuries. The total three-month mortality in penetrating cardiac and great vessels injury ranges from 18 to 42%, the presence of vital signs at the time of hospital admission is associated with 78-92% probability of survival. The surviving patients show excellent long-term results with the exception of those who suffered a severe damage to valve apparatus or with significantly depressed left ventricular function. CONCLUSIONS Our experience proves a high survival rate of patients with penetrating cardiac and great vessels injury. The centralisation of the care into the major trauma centre with a cardiac surgery background, a unified treatment algorithm, and a vital interdisciplinary cooperation are the key goal of successful management of these injuries. Key words:penetrating injury, cardiac injury, great vessel injury, outcome. Práce byla podporena programem institucionální podpor.


Assuntos
Vasos Coronários/lesões , Vasos Coronários/cirurgia , Traumatismos Cardíacos/cirurgia , Ferimentos por Arma de Fogo/cirurgia , Ferimentos Perfurantes/cirurgia , Adulto , Crime , Cuidados Críticos , República Tcheca/epidemiologia , Feminino , Traumatismos Cardíacos/mortalidade , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida , Centros de Traumatologia , Ferimentos por Arma de Fogo/mortalidade , Ferimentos Perfurantes/mortalidade
20.
Ann Card Anaesth ; 21(4): 427-429, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30333340

RESUMO

Traumatic aortic dissection following sudden deceleration injury requires urgent treatment as it may result in formation of aneurysm that may expand or rupture leading to catastrophe. Confirmation of diagnosis of aortic dissection often requires contrast-enhanced computed tomography (CECT) or magnetic resonance imaging, which is time-consuming. Often, there is a significant time lag between the CECT chest and surgical intervention. Progression of aortic dissections may be missed on CECT chest, which would be done in the initial hours after injury. Transesophageal echocardiography (TEE) is equally efficient for the diagnosis of aortic dissection. It may also provide additional information that can be very useful for the management. We report the case of a descending thoracic aortic dissection where TEE plays a crucial role during the surgical management of the patient.


Assuntos
Aneurisma Dissecante/diagnóstico por imagem , Falso Aneurisma/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Ecocardiografia Transesofagiana , Traumatismos Cardíacos/diagnóstico por imagem , Acidentes de Trânsito , Idoso , Aneurisma Dissecante/cirurgia , Falso Aneurisma/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/lesões , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Meios de Contraste , Traumatismos Cardíacos/cirurgia , Humanos , Masculino , Tórax/diagnóstico por imagem , Tomografia Computadorizada por Raios X
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