Blunt cardiac injury: analysis of 348 patients / 中华急诊医学杂志

Objective@#To explore the early diagnosis, therapeutic methods and efficacy for blunt cardiac injury (BCI).@*Methods@#All BCI patients from September 2003 to August 2018 were studied retrospectively in respect of sex, age, cause of injury, diagnostic methods, therapeutic procedures, and outcome. The patients were divided into two groups: nonoperative group (n=305) and operative group (n=43). The two groups were compared and analyzed.@*Results@#Totally 348 BCI patients accounted for 18.3% of 1 903 patients with blunt thoracic injury (BTI), and the mortality rate was 10.1%. The main cause of injury was traffic accident with an incidence of 48.3%. The diagnostic methods included electrocardiogram (ECG), enzymes and troponin I, echocardiography, and CT scanning, or confirmed by emergency thoracatomy. In the nonoperative group, patients were mainly myocardial contusion, with a mortality rate of 6.9%. In the operative group, patients were mainly cardiac rupture and pericardial hernia, and the mortality was 32.6%. The incidence of negative ECG between the two groups was not significantly different (16.7% vs 11.6%, P>0.05). The incidence of shock and mortality in the operative group were significantly higher than those in the the nonoperative group (P<0.01). The number of death directly resulted from BCI in the operative group was greater than that in the nonoperative group (P<0.05).@*Conclusions@#For BTI patients, BCI must be highly suspected, and necessary examinations should be given. To manage myocardial contusion without surgery, it is necessary to protect the heart, alleviate edema of myocardium, and control arrhythmia with drugs. To deal with those patients requiring operation, early recognition and expeditious thoracotomy are essential.

A risk score model for predicting cardiac rupture after acute myocardial infarction / 中华医学杂志(英文版)

Background:@#Cardiac rupture (CR) is a major lethal complication of acute myocardial infarction (AMI). However, no valid risk score model was found to predict CR after AMI in previous researches. This study aimed to establish a simple model to assess risk of CR after AMI, which could be easily used in a clinical environment.@*Methods:@#This was a retrospective case-control study that included 53 consecutive patients with CR after AMI during a period from January 1, 2010 to December 31, 2017. The controls included 524 patients who were selected randomly from 7932 AMI patients without CR at a 1:10 ratio. Risk factors for CR were identified using univariate analysis and multivariate logistic regression. Risk score model was developed based on multiple regression coefficients. Performance of risk model was evaluated using receiveroperating characteristic (ROC) curves and internal validity was explored using bootstrap analysis.@*Results:@#Among all 7985 AMI patients, 53 (0.67%) had CR (free wall rupture, n=39; ventricular septal rupture, n=14). Hospital mortalities were 92.5% and 4.01% in patients with and without CR (P < 0.001). Independent variables associated with CR included: older age, female gender, higher heart rate at admission, body mass index (BMI) <25 kg/m2, lower left ventricular ejection fraction (LVEF) and no primary percutaneous coronary intervention (pPCI) treatment. In ROC analysis, our CR risk assess model demonstrated a very good discriminate power (area under the curve [AUC]= 0.895, 95% confidence interval: 0.845–0.944, optimism-corrected AUC= 0.821, P < 0.001).@*Conclusion:@#This study developed a novel risk score model to help predict CR after AMI, which had high accuracy and was very simple to use.

Blunt cardiac injury: analysis of 348 patients / 中华急诊医学杂志

Objective To explore the early diagnosis,therapeutic methods and efficacy for blunt cardiac injury (BCI).Methods All BCI patients from September 2003 t9 August 2018 were studied retrospectively in respect of sex,age,cause of injury,diagnostic methods,therapeutic procedures,and outcome.The patients were divided into two groups:nonoperative group (n=305) and operative group (n=43).The two groups were compared and analyzed.Results Totally 348 BCI patients accounted for 18.3％ of 1 903 patients with blunt thoracic injury (BTI),and the mortality rate was 10.1％.The main cause of injury was traffic accident with an incidence of 48.3％.The diagnostic methods included electrocardiogram (ECG),enzymes and troponin I,echocardiography,and CT scanning,or confirmed by emergency thoracatomy.In the nonoperative group,patients were mainly myocardial contusion,with a mortality rate of 6.9％.In the operative group,patients were mainly cardiac rupture and pericardial hernia,and the mortality was 32.6％.The incidence of negative ECG between the two groups was not significantly different (16.7％ vs 11.6％,P＞0.05).The incidence of shock and mortality in the operative group were significantly higher than those in the the nonoperative group (P＜0.01).The number of death directly resulted from BCI in the operative group was greater than that in the nonoperative group (P＜0.05).Conclusions For BTI patients,BCI must be highly suspected,and necessary examinations should be given.To manage myocardial contusion without surgery,it is necessary to protect the heart,alleviate edema of myocardium,and control arrhythmia with drugs.To deal with those patients requiring operation,early recognition and expeditious thoracotomy are essential.

Pericardiocentesis can be nasty. Accidents do occur while “Rail-roading” Sheaths and pigtails!

Pericardiocentesis is a challenging procedure and complications may vary depending on the patient-specific risk factors and procedural indications. Cardiac chamber perforation and the subsequent insertion of pigtail catheter into the main pulmonary artery are an unreported mishap during attempted pericardiocentesis. This potentially life-threatening complication is completely preventable by identification of high-risk patients and appropriate use of available technologies. Adjunctive imaging decreases procedural risk for difficult-to-access pericardial fluid collections and must be used to prevent inadvertent morbidities.

Establishment of an acute pericardial effusion animal model guided by ultrasound / 中华超声影像学杂志

Objective To explore the feasibility of establishing an acute pericardial effusion animal model guided by ultrasound. Methods Six experimental pigs were anesthetized. A PTC needle was injected and guided to the right ventricular anterior wall under real-time high frequency ultrasound,40 ml and 80 ml normal saline were respectively infused into the pericardial cavity within 5 minutes. Ultrasonography and pathologic examination were applied to confirm this porcine model. The amount of the fluid was estimated by ultrasound at 1 hour and 8 hours after infusion. Results With ultrasound guidance,the PTC needle smoothly entered the pericardial cavity and the saline was successfully injected. The fluid dispersed from local to the entire pericardial cavity. Pericardial effusion last within 8 hours and no significant change of the fluid amount was found (all P ＞0.05). This acute pericardial effusion model was successfully established with a rate of 100%. Conclusions It is feasible to establish an animal model of acute pericardial effusion under the guidance of ultrasound. This method is safe,rapid and effective. It can provide a suitable animal model for the study of acute pericardial effusion.

Influence factors cause prolonged ICU stay in cardiac rupture patients after operations / 中华急诊医学杂志

Objective To investigate the influence factors on length of ICU stay in cardiac rupture patients after surgical repair.Methods A retrospective study was conducted and enrolled survived cardiac rupture patients admitted to ICU of Wuxi People's Hospital from January 2009 to January 2017.Clinical data of patients were recorded including age,causes,complications,blood transfusion,duration of mechanical ventilation,duration of vasoactive agent employment,and length of ICU stay.At the same time,the laboratory findings were documented including hemoglobin(Hb),hematocrit (Hot),serum creatinine,blood lactic acid and creatine kinase muscle b(CK-MB).Patients were divided into two groups according to length of ICU stay(A group ＞3 d,B group ≤ 3 d).Data were analyzed using SPSS20.0 and MedCalc software.Pearson correlation test and ROC curve were taken to analyze the predicting factors for the prognosis.Results Twenty-two patients were referred to ICU after operation and survived.The length of ICU stay varied from 2 to 12 d.The statistical analysis showed the levels of Hb and Hct in group A were lower than those in group B (P＜0.05);the levels of CK-MB and lactic acid in group A were higher than those in group B (P＜0.05);and larger volume of blood transfusion (P=0.002),higher complications (P=0.024),longer duration of mechanical ventilation (P=0.001) and longer duration of vasopressor application (P=0.003) were found in group A.Pearson correlation test showed Hb and Hct had negative correlation with duration of mechanical ventilation,duration of vasoactive agent application and length of ICU stay (P＜0.05),whereas the CK-MB and lactic acid had positive correlation with duration of mechanical ventilation,duration of vasoactive agent employment and length of ICU stay (P＜0.05).ROC curve showed lactic acid,Hct,and CK-MB all had significance in prediction of prolonged ICU stay,and there were no statistically significant differences in areas under the curve(AUC) among these three biomarkers (P＞0.05).With the employment of ROC curve,the optimal cut-off points of three biomarkers for clinical diagnosis were lactic acid ≥ 3.4 mmol/L,Hct ≤ 39％,CK-MB ≥ 58 U/L.Conclusion Hb,Hct,lactic acid,CK-MB,blood transfusion,complications,duration of mechanical ventilation,duration of vasoactive agent employment were factors influencing on length of ICU stay in cardiac rupture patients after operations.The levels of lactic acid,Hct,and CK-MB had significance in prediction of prolonged ICU stay.

Rupture of the myocardium in autopsied MI hearts / Ruptura do miocárdio em corações com IM autopsiados

Summary Although myocardial rupture occurs in only 2% to 4% of cases of acute myocardial infarction (AMI), there is a high mortality rate due to acute cardiogenic shock. We present the anatomopathological findings of three cases of myocardial rupture in autopsied hearts in the last 30 years, with a diagnosis of cardiac rupture in acute myocardial infarction. In these 30 years the percentage of AMI with myocardial rupture was 0.2%. Risk factors for post-AMI myocardial rupture include older age, atherosclerosis, diabetes mellitus and systemic arterial hypertension.

Resumo Embora a ruptura do miocárdio ocorra em apenas 2 a 4% dos casos de infarto agudo do miocárdio (IAM), está associada a alta mortalidade, principalmente em decorrência do estado de choque cardiogênico agudo. São apresentados os achados anatomopatológicos de três casos de ruptura do miocárdio de pacientes autopsiados nos últimos 30 anos, com diagnóstico de ruptura cardíaca em decorrência de IAM. Nesse período, a porcentagem de IAM com ruptura do miocárdio foi de 0,2%. Os fatores de risco para ruptura do miocárdio pós-IAM incluem idade avançada, arteriosclerose, diabetes mellitus e hipertensão arterial sistêmica.

Clinical characteristics of recent death in patients with acute myocardial infarction complicated with cardiac rupture / 中国中西医结合急救杂志

Objective To investigate the clinical characteristics of patients with acute myocardial infarction (AMI) complicated with cardiac rupture (CR) and to explore the risk factors for the survival time of AMI combined with CR. Methods A retrospective study was conducted. The clinical data of 75 hospitalized patients with the confirmed diagnosis of AMI combined with free wall rupture (FWR) or ventricular septal rupture (VSR) admitted to Guangdong General Hospital from April 2009 to March 2015 were collected. They were divided into a survival < 30-day group (42 cases) and a survival ≥ 30-day (33 cases) group, and their clinical characteristics were analyzed. Receiver operating characteristic curve (ROC curve) was drawn, and the predictive value of each indicator for the patient's 30-day survival time was analyzed. Results The number of female patients (25 cases vs. 0 case) and the number of patients without diabetes (36 cases vs. 21 cases) in the survival < 30-day group were significantly higher than those in survival ≥ 30-day group (all P < 0.05). Therefore, both female and without diabetes were risk factors for the recent death of AMI complicated with CR. In the survival ≥ 30-day group, the number of patients with right coronary artery (RCA) lesions and immediately undergoing early percutaneous coronary intervention therapy (PCI) was significantly higher than that in survival < 30-day group (11 cases vs. 4 cases, P < 0.05). Therefore, the RCA lesion and immediately undergoing early PCI therapy was a recent survival protective factor. ROC curve analysis showed that AMI female and combined with diabetes and lesions in RCA had a certain predictive value for survival time of the patients, the area under ROC curve (AUC) and 95% confidence interval (95%CI) were 0.798 (0.696-0.899), 0.592 (0.542-0.743) and 0.647 (0.500-0.794) respectively, sensitivity and specificity were 34.6%, 16.1% and 42.3% and 12.9% respectively, all P < 0.05. Conclusions Women and without diabetes are the risk factors of recent death of AMI complicated by CR, and in patients with AMI complicated with CR and the involved lesion being RCA, PCI therapy should be performed as early as possible that may elevate the 30-day survival rate for the patients.

Analysis of clinical characteristics and death causes in patients with acute myocardial infarction complicated by cardiac rupture / 中国综合临床

Objective To analyze death causes in patients with acute myocardial infarction complicated by cardiac rupture.Methods The patients who were admitted with cardiac rupture after acute myocardial infarction in Beijing Anzhen Hospital Affiliated to Capital Medical University from January 2012 to December 2014 were enrolled.These patients were divided into death group and survival group.Then statistical analysis was performed for the clinical data of these patients in two groups,Logistic regression analysis was used to analyze the risk factors with statistical significance.Results A total of 59 patients diagnosed cardiac rupture after acute myocardial infarction were enrolled in this study,including 50 patients died,and 9 patients survived.There were significant differences between the two groups of patients with clinical baseline data.Compared with the survival group,death group had higher age ((69.94 ± 9.24) years old vs.(61.56 ± 9.14) years old,t =2.511,P =0.015),the higher incidence of malignant arrhythmia (22.0％ vs.0,x2 =4.070,P =0.044),the lower proportion of alcohol abuse (12.0％ vs.44.4％,x2 =5.704,P =0.017),higher fasting blood glucose ((8.97 ±3.98) mmol/L vs.(6.06± 1.25) mmol/L,t =4.153,P＜0.01) and triglycerides ((1.78±0.50) mmol/L vs.(1.39±0.20) mmol/L,t =4.146,P＜0.01),higher proportion of pulmonary arterial hypertension(22.0％ vs.0,x2 =4.070,P =0.044) and brain natriuretic peptide (406.50 (110.00,570.28) ng/L vs.33.00 (20.00,176.00) ng/L,P=0.004),smaller the left ventricular end diastolic diameter((47.76±5.13) mm vs.(52.22 ±4.66) mm,t =-2.434,P =0.018).The use of fondaparinux sodium (26.0％ vs.0,x2 =4.920,P =0.027),heparin (48.0％ vs.88.9％,x2 =5.138,P =0.023) and nitrates (72.0％ vs.100.0％,x2 =5.361,P =0.021)were significantly differences.The occurrence of acute heart failure in patients in death group was significantly higher than the survival group (11.0％ vs.0,x2 =3.258,P =0.071),but the difference was not significant.Logistic regression analysis showed that old age (OR =1.151),fasting blood glucose (OR =1.974)and heart rupture were significandy correlated (P＜ 0.05).Conclusion Cardiac rupture patients have a high mortality rate after myocardial infarction.Advanced age and fasting blood glucose were risk factors,while the use of common heparin is protective factor.Patients should be evaluated in a timely manner to assess the prognosis and to take targeted measures.

Clinical characteristics of recent death in patients with acute myocardial infarction complicated with cardiac rupture / 中国中西医结合急救杂志

Objective To investigate the clinical characteristics of patients with acute myocardial infarction (AMI) complicated with cardiac rupture (CR) and to explore the risk factors for the survival time of AMI combined with CR. Methods A retrospective study was conducted. The clinical data of 75 hospitalized patients with the confirmed diagnosis of AMI combined with free wall rupture (FWR) or ventricular septal rupture (VSR) admitted to Guangdong General Hospital from April 2009 to March 2015 were collected. They were divided into a survival < 30-day group (42 cases) and a survival ≥ 30-day (33 cases) group, and their clinical characteristics were analyzed. Receiver operating characteristic curve (ROC curve) was drawn, and the predictive value of each indicator for the patient's 30-day survival time was analyzed. Results The number of female patients (25 cases vs. 0 case) and the number of patients without diabetes (36 cases vs. 21 cases) in the survival < 30-day group were significantly higher than those in survival ≥ 30-day group (all P < 0.05). Therefore, both female and without diabetes were risk factors for the recent death of AMI complicated with CR. In the survival ≥ 30-day group, the number of patients with right coronary artery (RCA) lesions and immediately undergoing early percutaneous coronary intervention therapy (PCI) was significantly higher than that in survival < 30-day group (11 cases vs. 4 cases, P < 0.05). Therefore, the RCA lesion and immediately undergoing early PCI therapy was a recent survival protective factor. ROC curve analysis showed that AMI female and combined with diabetes and lesions in RCA had a certain predictive value for survival time of the patients, the area under ROC curve (AUC) and 95% confidence interval (95%CI) were 0.798 (0.696-0.899), 0.592 (0.542-0.743) and 0.647 (0.500-0.794) respectively, sensitivity and specificity were 34.6%, 16.1% and 42.3% and 12.9% respectively, all P < 0.05. Conclusions Women and without diabetes are the risk factors of recent death of AMI complicated by CR, and in patients with AMI complicated with CR and the involved lesion being RCA, PCI therapy should be performed as early as possible that may elevate the 30-day survival rate for the patients.

Disrupción auriculoventricular posterior a reoperación de reemplazo valvular mitral: reparación y evaluación ecocardiográfica / Atrioventricular disruption posterior to reoperation of mitral valve replacement: repair and echocardiographic evaluation

La disrupción auriculoventricular después del reemplazo valvular mitral es una rara pero letal complicación. Este caso es el de una mujer de 72 años de edad, con antecedentes de: reemplazo valvular aórtico, mitral, plastia tricúspide y Maze. Se llevó al reemplazo valvular mitral con prótesis Hancock 29 mitral. Se trasladó a la UCI y el curso postoperatorio fue normal hasta las 24 horas después de la cirugía, cuando presentó disnea y requirió soporte inotrópico. Se le realizó un angiotac y un ecocardiograma transtorácico que evidenció pseudoaneurisma ventricular. Fue llevada a cirugía, se inició circulación extracorpórea. Se evidenció disrupción auriculoventricular en el anillo posterior de la válvula mitral (tipo I perforación). La ruptura fue cerrada con un parche mixto de pericardio bovino y dacron con sutura continua. Actualmente, la paciente está en buenas condiciones sin recurrencia. Investigamos: el caso, la etiología, el reparo quirúrgico y la prevención de esta rara complicación y se discute.

Atrioventricular disruption after a mitral valve replacement is a rare but fatal complication. A case of 72 year-old woman is presented. She had a medical history of aortic and mitral valve replacement and Maze and tricuspid valve surgery. Mitral valve replacement was performed with Hancock 29 mitral prosthesis. She was taken to ICU and postoperative progress was normal until 24 hours after the surgery, when she developed dyspnea and required inotropic support. A CT angiography and transthoracic echocardiogram were performed, which evidence a ventricular pseudoaneurysm. She was taken to the operating room to start extracorporeal circulation. Atrioventricular disruption was evidenced in the posterior mitral annulus (type I perforation). Rupture was closed with a using a mixed Dacron and bovine pericardial patch with continuous suture. Patient is currently in good condition with no recurrence. Case, etiology, surgical repair and prevention of this rare complication were investigated and discussed.

Clinical characteristics and prognosis of patients with acute myocardial infarction complicated with different parts of heart rupture / 中华危重病急救医学

Objective To analyze the clinical features and prognosis of patients with acute myocardial infarction (AMI) complicated with different parts of heart rupture. Methods Patients diagnosed for AMI complicated with cardiac rupture from January 2010 to December 2015 in Beijing Anzhen Hospital were collected. All of them were divided into free wall rupture group and ventricular septal perforation group according to the rupture site. Clinical features, hospital related examination results, treatment and prognosis of these two groups were analyzed statistically. Results A total of 120 patients with AMI complicated with cardiac rupture were included in the study, including 64 patients with free wall rupture, and 56 patients with ventricular septal perforation. Compared with the ventricular septal perforation group by the single factor analysis, the patients in free wall rupture group had higher age (year: 68.88±9.31 vs. 63.86±8.68, t = 3.039, P = 0.003), lower body mass index [BMI (kg/m2): 22.74±2.07 vs. 25.21±2.99, t = -5.203, P = 0.000], higher rate of history of renal insufficiency (12.5% vs. 1.8%, χ2 = 4.942, P = 0.026), higher level of aspartate transaminase [AST (U/L): 76.00 (38.33, 197.50) vs. 33.50 (19.00, 137.50), Z = -2.788, P = 0.005], triglyceride [TG (mmol/L): 1.68±0.50 vs. 1.36±0.70, t = 2.903, P = 0.005], total cholesterol [TC (mmol/L): 4.21±0.74 vs. 3.87±1.01, t = 2.081, P = 0.040], high density lipoprotein cholesterol [HDL-C (mmol/L): 1.12±0.91 vs. 0.91±0.32, t = 2.910, P = 0.004] and cardiac troponin I [cTnI (μg/L): 18.83 (4.48, 81.68) vs. 0.82 (0.08, 8.50), Z =-5.011, P = 0.000], lower level of blood urea nitrogen [BUN (mmol/L): 7.11±3.11 vs. 10.14±6.97, t = -2.999, P = 0.004], brain natriuretic peptide [BNP (ng/L): 169.00 (98.50, 485.75) vs. 793.00 (478.75, 1 426.25), Z = -5.739, P = 0.000], and D-dimer [μg/L: 219.00 (141.00, 315.75) vs. 310.50 (188.75, 532.00), Z = -2.607, P = 0.009], smaller left ventricular end diastolic diameter [LVEDD (mm): 48.58±5.17 vs. 53.65±6.63, t = -4.631, P = 0.000] and left ventricular end systolic diameter [LVESD (mm): 33.54±5.40 vs. 37.24±6.53, t = -3.397, P = 0.001], lower proportion of left ventricular aneurysm formation [14.1% (9/64) vs. 76.8% (43/56), χ2 = 47.851, P = 0.000] and pulmonary arterial hypertension [20.3% (13/64) vs. 53.6% (30/56), χ2 = 14.368, P = 0.000], higher usage rate of aspirin [100% (64/64) vs. 75.0% (42/56), χ2 = 18.113, P = 0.000], clopidogrel usage rate [82.8% (53/6) vs. 46.4% (26/56), χ2 = 17.578, P = 0.000], ticagrelor usage rate [12.5% (8/64) vs. 1.8% (1/56), χ2 = 4.924, P = 0.026], and common heparin usage rate [53.1% (34/64) vs. 10.7% (6/56), χ2 = 24.174, P = 0.000], lower usage rate of nitrates [70.3% (45/64) vs. 85.7% (48/56), χ2 = 4.063, P = 0.044], higher percutaneous coronary intervention (PCI) operation rate [42.9% (27/64) vs. 12.5% (7/56), χ2 = 13.388, P = 0.000], lower coronary artery bypass graft (CABG) surgery rate [7.8% (5/64) vs. 48.2% (27/56), χ2 = 24.930, P = 0.000], success rate of CABG surgery [60.0% (3/5) vs. 100% (27/27), χ2 = 8.233, P = 0.004], and incidence rate of cerebral infarction in hospital [1.6% (1/64) vs. 10.7% (6/56), χ2 = 4.554, P = 0.033], higher hospital all-cause mortality [85.9% (55/64) vs. 23.2% (13/56), χ2 = 47.851, P = 0.000]. The differences of other indicators were not statistically sig nificant. Conclusions Patients with AMI complicated with free wall rupture usually have more risk factors and worse prognosis. These two types of patients should be treated with target.

A Case Control Study for Risk Factors in Patients of Acute Myocardial Infarction Complicated With Cardiac Rupture / 中国循环杂志

Objective: To analyze clinical characteristics and risk factors in patients with acute myocardial infarction (AMI) complicated with cardiac rupture (CR) and to explore the prevention and treatment strategy in clinical practice. Methods: A case control study was conducted in 2 groups: CR group, the patients with coronary angiography conifrmed AMI with CR,n=44 and Control group, the patients with simultaneous STEAMI and by 1:3 pair-matched ratio,n=132. Clinical information was compared between 2 groups and the relevant risk factors for predicting CR were studied by Logistic regression analysis. Results: Compared with Control group, CR group had the lower ratio of β-receptor blocker application (22.7% vs 81.4%),P<0.05. Univariate regression analysis indicated that lower body mass index, incipient MI, anterior MI, no-reperfusion therapy, delayed reperfusion therapy, lower blood pressure at admission, post-infarction angina, ventricular aneurysm, higher Gensini score, high blood levels of cretinine and BNP, low ejection fraction were the risk factors for CR occurrence in STEAMI patients, allP<0.05. Multivariate regression analysis presented that incipient MI (P<0.049, OR=7.462), post-infarction angina (P<0.000, OR=8.591), ventricular aneurysm (P<0.005, OR=4.617) and higher Gensini score (P<0.001, OR=2.788) were risk factors for CR occurrence in STEAMI patients. Conclusion: Incipient MI, post-infarction angina, ventricular aneurysm and higher Gensini score are the risk factors for CR occurrence in STEAMI patients.

Ecocardiografía en infarto agudo del miocardio / Echocardiography in acute myocardial infarction

La ecocardiografía es la primera línea de diagnóstico en la fase aguda del infarto agudo del miocardio. Provee información invaluable sobre la estratificación de riesgo, valoración a corto y largo plazo, características hemodinámicas y utilidad en el reconocimiento de la mayoría de complicaciones mecánicas relacionadas con dicho evento. En este artículo se describen algunos parámetros ecocardiográficos que han mostrado evidencia para detectar pacientes en riesgo de pobre pronóstico así como para determinar el tratamiento y las intervenciones de los síndromes coronarios agudos. En conclusión, la ecocardiografía brinda información pronóstica significativa en el manejo de pacientes con infarto agudo del miocardio y debería emplearse en la evaluación rutinaria de este tipo de pacientes.

Echocardiography is the first line of diagnosis in the acute phase of myocardial infarction. It provides invaluable information about risk stratification, assessment of short and long term prognosis, hemodynamic features, and helps to identify the most common mechanical complications related to acute myocardial infaction. In this article, some of the echo cardiographic parameters are decribed that have provided evidence for the detection of those patients at risk of a poor prognosis, and equally important to determine the treatment and interventions in acute coronary syndromes. In conclusion, echocardiography provides strong prognostic information in the management of patients with recent myocardial infarction and should be used always in the routine evaluation of these patients.

Clamshell Thoracotomy for Two Cases of Blunt Traumatic Cardiac Rupture / 日本心臓血管外科学会雑誌

When a sufficient field of view in unilateral thoracotomy cannot be obtained during hemostasis surgery for severe thoracic trauma, clamshell thoracotomy is often necessary to perform aortic cross-clamping in order to avoid cardiac arrest or to treat intrathoracic injury across the chest. Here we describe two successful cases of clamshell thoracotomy for blunt traumatic cardiac rupture. Case 1 was a 41-year-old male motorcyclist, injured in a collision with a truck, who was in a state of shock when transported to our emergency department (ED). Due to the finding of fluid accumulation around the spleen on FAST (focused assessment with sonography for trauma), he underwent emergency laparotomy with gauze packing after splenectomy as damage control surgery. Because of a prolonged state of shock due to extensive right hemothorax, right anterolateral thoracotomy was performed to locate the site of active bleeding in the right mediastinal pleura. However, imminent cardiac arrest necessitated clamshell thoracotomy, which revealed a 4-cm laceration on the right atrium and two lacerations on the upper lobe of the right lung, for which suture repair was performed. His postoperative course was uneventful and he was discharged on postinjury day 57 for rehabilitation. Case 2 was a 75-year-old female motorcyclist who was injured after hitting a curb and falling. She was in a state of shock due to severe right hemothorax when admitted to our ED and underwent anterolateral thoracotomy to treat active bleeding in the right mediastinal pleura. Clamshell thoracotomy was performed because cardiac arrest was imminent, and this was followed by suture repair of a 2-cm laceration identified on the left atrium. Her postoperative course was uneventful and she was transferred to another hospital on postinjury day 37 for rehabilitation. In both cases, Clamshell thoracotomy was performed successfully for blunt traumatic cardiac rupture and the postoperative course was good with no serious complications. Clamshell thoracotomy is an effective approach for trauma resuscitation, so surgeons should be familiar with its indications, surgical techniques, and timing.

Perforación tardía del ventrículo derecho con electrodo de fijación activa en el septum y estimulación diafragmática como primera manifestación clínica / Late right ventricular perforation with active fixation electrode in the septum with diaphragmatic stimulation as first clinical manifestation

La perforación miocárdica es una complicación infrecuente, relacionada con el implante de marcapasos y cardiodesfibriladores, que puede ocurrir al insertar los electrodos; sin embargo, en relación con la utilización de electrodos de fijación activa, ésta puede suceder después de varios días o semanas del implante. Se describe un caso clínico de un paciente a quien se le implantó un marcapasos bicameral con electrodos de fijación activa evidenciándose una semana más tarde perforación miocárdica por el electrodo ventricular, con estimulación diafragmática como manifestación clínica. Inicialmente no había evidencia radiológica de la perforación y requirió abordaje endovascular para extracción.

Myocardial perforation is a rare complication of pacemakers and defibrillators implantation that can occur when inserting the electrodes. However, regarding the use of active fixation electrodes, perforation can occur several days or weeks after the implant . We describe the case of a patient who was implanted a dual chamber pacemaker with active fixation electrodes. A week later we evidenced myocardial perforation by the ventricular electrode with diaphragmatic stimulation as clinical manifestation. Initially there was no radiological evidence of perforation and it required endovascular approach for extraction.

Experience in the surgical treatment of 16 cases of cardiac rupture caused by blunt chest trauma / 中国综合临床

ObjectiveTo retrospectively analyze the experience in the treatment of cardiac rupture caused by blunt chest trauma and to explore the approaches and methods to improve patient survival.Methods From 2004 to 2010,16 cases of closed chest trauma caused by cardiac rupture,who were treated in our hospital,were treated by heart repair using median sternotomy incision approach.Results Except for 1 patient occurred cardiac arrest before the establishment of CPB,who was failed for cardiopulmonary resuscitation after surgical repair,the remaining 15 patients were all successfully treated.Conclusion The diagnosis of cardiac rupture should be made as soon as possible once it occurs.Timely and decisive rescue and emergency surgery should be given.Heart repair can greatly improve the patient's survival.

Application of Percutaneous Cardiopulmonary Support for Cardiac Tamponade Following Blunt Chest Trauma: Two Case Reports

Since the advent of percutaneous cardiopulmonary support (PCPS), its application has been extended to massively injured patient. Cardiac injury following blunt chest trauma brings out high mortality and morbidity. In our cases, patients had high injury severity score by blunt trauma and presented sudden hemodynamic collapse in emergency room. We quickly detected cardiac tamponade by focused assessment with sonography for trauma and implemented PCPS. As PCPS established, their vital sign restored and then, they were transferred to the operation room (OR) securely. After all injured lesion repaired, PCPS weaned successfully in OR. They were discharged without complication on day 26 and 55, retrospectively.

Successful Treatment of Blunt Traumatic Rupture of the Left Atrial Appendage and Pericardium: A Case Report

Blunt cardiac rupture is uncommon and is associated with significant mortality. Patients with blunt cardiac rupture usually have combined injury and do not always show signs of cardiac tamponade, which delays the diagnosis of cardiac rupture and increases mortality. We report a case of cardiac rupture diagnosed and treated by using only thoracic exploration based on clinical impression, with radiologic studies, including even echocardiography, showing negative results.

Successful Treatment of Blunt Traumatic Rupture of the Left Atrial Appendage and Pericardium: A Case Report

Blunt cardiac rupture is uncommon and is associated with significant mortality. Patients with blunt cardiac rupture usually have combined injury and do not always show signs of cardiac tamponade, which delays the diagnosis of cardiac rupture and increases mortality. We report a case of cardiac rupture diagnosed and treated by using only thoracic exploration based on clinical impression, with radiologic studies, including even echocardiography, showing negative results.