"I Tripped and Broke My Heart": A Case Report of Right Atrial Rupture.

A 66-year-old woman tripped and fell onto outstretched hands. She did not hit her chest. She developed chest pain and presented to the emergency department in shock. Transthoracic echocardiography demonstrated a large pericardial effusion with cardiac tamponade. Despite recurrent pericardiocentesis, the fluid did not decrease on echocardiography, and she continued to be in profound shock. Emergent surgical exploration identified rupture of the right atrium at its insertion into the superior vena cava. This case demonstrates atrial rupture despite no obvious direct chest impact and emphasizes the need for emergent surgical exploration in patients with hemopericardium and persistent tamponade despite pericardiocentesis.

Après avoir trébuché, une femme âgée de 66 ans est tombée sur ses mains étendues. Son thorax n'a pas touché le sol. Elle a par la suite éprouvé une douleur thoracique et s'est présentée au service des urgences en état de choc. Une échocardiographie transthoracique a révélé un important épanchement péricardique et une tamponnade cardiaque. Malgré des péricardiocentèses répétées, le volume de liquide observé à l'échocardiographie ne diminuait pas et la patiente était toujours en état de choc profond. Une exploration chirurgicale d'urgence a permis de détecter une rupture de l'oreillette droite au lieu de son insertion dans la veine cave supérieure. Le cas de cette patiente démontre qu'une rupture auriculaire est possible même sans impact direct au thorax et fait ressortir l'importance d'une exploration chirurgicale d'urgence chez les patients hémopéricardiques présentant une tamponnade qui persiste malgré une péricardiocentèse.

Pericardial effusions: do they all require pericardiocentesis?

Pericardial effusions are associated with multiple disorders, the causes of which are dependent on local epidemiologic and patient-specific factors. Pericardial effusions exhibit a broad spectrum of clinical presentations and may or may not be symptomatic. Echocardiographically guided pericardiocentesis should be reserved for patients with hemodynamic compromise, an intrathoracic mass effect, or an uncertain cause. Not all patients with pericardial effusions require pericardiocentesis, and an algorithmic approach to the decision to perform pericardiocentesis is recommended.

Metal-catalyzed reduction of HCONR'2, R' = Me (DMF), Et (DEF), by silanes to produce R'2NMe and disiloxanes: a mechanism unraveled.

We demonstrate that using Mo(CO)(6), Mo(CO)(5)NMe(3), and (η(5)-C(5)H(5))Mn(CO)(3) as catalysts for the silane, R(3)SiH, reduction of N,N-dimethylformamide (DMF), and N,N-diethylformamide (DEF), we can observe, intercept, and isolate, the important siloxymethylamine intermediates, R(3)SiOCH(2)NR'(2), R' = Me, Et, for the first time. In the presence of excess DMF such intermediates thermally react with a variety of silanes to form the corresponding disiloxanes in the absence of a metal catalyst. We also show that the germanium hydrides, Et(3)GeH and Bu(3)GeH, also reduce DMF to form trimethylamine and the corresponding digermoxane but observe no intermediates R(3)GeOCH(2)NMe(2). Bu(3)SnH reduces DMF, but along with the low yields of Bu(3)SnOSnBu(3) (but no Bu(3)SnOCH(2)NMe(2)) significant side products are obtained including (Bu(3)Sn)(2) and Bu(4)Sn. In the absence of DMF the siloxymethylamines can undergo metal-catalyzed reactions with silanes, germanes and stannanes to form disiloxanes, and R(3)SiOER(3) E = Ge, Sn, respectively. To date, the most efficient catalyst for this latter process is (η(5)-C(5)H(5))Mo(CO)(3)CH(3) via a photochemical reaction.

Hypertrophic obstructive cardiomyopathy complicated by ruptured chordae tendinea to the posterior mitral leaflet and severe congestive heart failure.

A 63-year-old woman with hypertrophic obstructive cardiomyopathy developed rapidly progressive fatigue, shortness of breath and congestive heart failure. A transesophageal echocardiogram demonstrated ruptured chordae to the posterior mitral valve leaflet with severe mitral regurgitation. Mitral valve replacement eliminated the outflow gradient. Acute or subacute hemodynamic deterioration in a patient with hypertrophic obstructive cardiomyopathy should lead to a search for associated lesions.

Myocardial infarction and left ventricular free wall rupture in a patient with a prior pericardiectomy.

A 59-year-old man with an inferolateral myocardial infarction and cardiogenic shock was found to have extensive intrathoracic hemorrhage in communication with the left ventricle. His remote pericardiectomy precluded hemopericardium and tamponade, and permitted the establishment of an unusual diagnosis and subsequent closure of the site of myocardial perforation.