Traumatic Coronary Artery Dissection Research Articles

P227 THE UNEXPECTED CONSEQUENCES OF A 30 METERS FALL

Abstract Introduction Acute myocardial infarction (AMI) is a rare but often lethal consequence of a blunt cardiac trauma. Falls leading to coronary artery dissections are rare, thus underlining the lack of experience in their management. Case report description: a 55–year–old male patient with type 2 diabetes and no relevant past medical history was admitted to our hospital facility after a 30–meter fall during rock–climbing. On arrival, he was hemodynamically and neurologically stable. He underwent a full trauma evaluation: multiple facial bones fractures were diagnosed. An electrocardiogram revealed a QS morphology of the QRS and ST elevation in the precordial lead from V1 to V3 with reciprocal ST depression in the inferior leads. High sensitivity (hs) Troponin T was slightly elevated (49 ng/L, normal values <14 ng/L). A cardiac ultrasound documented a left ventricular dysfunction (LVEF 40%) with akinesia of mid–apical antero–septal and anterior walls. Biomarkers further increased with Troponin reaching 199 ng/L and creatinine phosphokinase–MB 24,7 ug/L (normal value <5 ug/L). Coronary angiography demonstrated proximal occlusion of the left anterior descending (LAD) coronary artery with an image consistent with traumatic coronary artery dissection, confirmed by a cardiac CT scan showing the proximal occlusion of the LAD with retrograde perfusion of its downstream portion. Considering the left ventricular dysfunction, the elevation of cardiac biomarkers (peak CK–MB 187 ug/L, peak hs troponin T 5400 ng/L) and the acceptable hemorrhagic risk in spite of the need for facial surgery, a coronary angioplasty was performed. A dual antiplatlet therapy with acetilsalicidic acid and clopidogrel began. Nine days later the patient underwent the maxillo–facial surgery: clopidogrel was stopped provisionally and a bridge strategy using tirofiban was chosen. Post–operatory was uneventful. A full recovery of cardiac function was assessed after one year (LVEF of 55%). Discussion Few cases of blunt cardiac trauma with coronary artery dissections have been reported and treated successfully, with the LAD being the most frequently involved vessel (76%). If urgent non–cardiac surgery can be postponed, a percutaneus revascularization eventually followed by tirofiban as bridge therapy can be suggested, carefully considering the risk of stent thrombosis and the hemorrhagic risk conveyed by the trauma itself.

Traumatic coronary artery dissection with total occlusion of left descending coronary artery: to stent or not to stent.

Traumatic coronary artery dissection with total occlusion of left descending coronary artery: to stent or not to stent.

Traumatic Coronary Artery Dissection Diagnosed Immediately with Cardiac CT

A young male presented with chest pain after blunt chest wall trauma. Immediate CT coronary angiography demonstrated a spiral dissection of the right coronary artery. CT fractional flow reserve confirmed modest flow limitation so the patient was treated medically. At follow-up CT the vessel had healed and CT fractional flow reserve had normalised.

Throws of Death: Traumatic Coronary Artery Dissection Resulting From Jiu Jitsu Training.

The risk of cardiac injury in blunt thoracic trauma is quite rare, occurring in only 0.1% of patients. The least common cardiac injury is coronary artery dissection. Most cardiac injuries result from high-energy mechanisms such as motor vehicle collisions. Even low-mechanism injuries that have been reported involved rapid deceleration. We present a case of traumatic coronary artery dissection that resulted from a low-energy blunt thoracic injury with no rapid deceleration. This patient had no other associated thoracic injuries, such as rib fractures or sternal fracture. Following presentation, our patient twice deteriorated into ventricular fibrillation and was successfully resuscitated each time. The coronary lesion was successfully stented and the patient was eventually discharged home. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case underscores the importance of maintaining a high level of suspicion for coronary artery dissection even in low-energy mechanisms. An electrocardiogram should be obtained early, even in low-energy mechanisms. While patients with traumatic cardiac injuries will commonly present with other injuries, such as rib fractures, the absence of these injuries does not rule out cardiac injury.

Case Report: Cardiac arrest due to traumatic coronary artery dissection treated by extracorporeal membrane resuscitation

Traumatic coronary artery dissection, which is rare in blunt trauma, has high risk of acute myocardial infarction and cardiac arrest. A 44-year-old man who had a traffic accident was transferred to the emergency department with refractory ventricular fibrillation (VF). After conventional cardiopulmonary resuscitation, we introduced extracorporeal cardiopulmonary resuscitation (ECPR) and obtained return of spontaneous circulation with ST-elevation electrocardiogram at V4-6. Subsequent coronary angiography and intravascular ultrasound supported by extracorporeal membrane oxygenation (ECMO) revealed complete occlusions of left anterior descending and left circumflex artery due to dissections. Drug-eluting stents were placed with restorations of TIMI 2 flows. After ICU admission, his left ventricular function gradually recovered; he was successfully weaned from VA-ECMO on day 9. ECPR may be a valuable option to allow time and stable hemodynamic condition to treat the cause of cardiac arrest.

TRAUMATIC CORONARY ARTERY DISSECTION

Traumatic coronary artery dissection rarely causes acute myocardial infarction, ventricular arrhythmia or sudden death. A 40-year-old unrestrained driver presented unresponsive and hypotensive after an intentional suicidal motor collision. ECG showed inferior ST- elevation with right ventricular (

TRAUMATIC PROXIMAL LEFT ANTERIOR DESCENDING ARTERY DISSECTION: USE OF NEAR INFRARED SPECTROSCOPY INTRAVASCULAR ULTRASOUND IN THE DIFFERENTIAL DIAGNOSIS

Traumatic coronary artery dissection is rare. Near Infrared Spectroscopy Intravascular Ultrasound (NIRS IVUS) during coronary angiography may be utilized in cases of uncertainty. NIRS provides information on lipid core plaque (LCP) which may be implicated in acute coronary syndrome. A 29 year old

Ventricular Fibrillation Caused by Traumatic Coronary Artery Dissection

Coronary artery dissection due to blunt chest trauma (traumatic coronary artery dissection [TCAD]) may heal spontaneously, and some surgeons believe that conservative or elective treat-ments are sufficient, provided that there are no progressing ischemic symptoms. However, we report a patient who experienced sudden ventricular fibrillation (VF) during initial medical care for trauma injuries. The 32-year-old woman was riding in a passenger car when an accident occurred, and was subsequently transported to our emergency department. Twelve-lead electrocardiography revealed ST segment elevation in leads II, III, and aVF, although her vital signs remained stable. Therefore, we prioritized assessing the trauma at other sites, and VF suddenly occurred. Coronary angiography was performed with repeated defibrillation and chest compressions, which resulted in recovery of spontaneous circulation. Occlusion was observed in the right coronary artery, which we treated with balloon angioplasty. However, intravascular ultrasonography (IVUS) subsequently revealed coronary artery dissection, a stent was placed, and the patient successfully recovered. Therefore, IVUS may be useful for diagnosing TCAD, and swift intervention is needed if TCAD is detected.

Cardiovascular magnetic resonance of acute myocardial infarction following traumatic coronary artery dissection

Traumatic coronary artery dissection is a very rare cause of myocardial infarction. Occurrence of this condition late in the posttraumatic period is extremely uncommon. We present a case of a young patient with acute myocardial infarction 4 weeks after blunt chest trauma. Coronary angiography showed left anterior descending artery dissection as well as thrombus formation, and multiple small infarctions were shown by cardiovascular magnetic resonance.

A blunt chest trauma causing left anterior descending artery dissection and acute myocardial infarction treated by deferred angioplasty

Traumatic coronary artery dissection is an uncommon cause of acute myocardial infarction (AMI). We report a case of blunt chest trauma resulting from a motorcycle collision causing ostial dissection of the left anterior descending (LAD) artery in a 31-year-old previously healthy male. The patient also suffered from compound comminuted fractures of the humerus and ulna and severe liver laceration, which hampered both percutaneous and surgical acute revasularization. After a stormy hospital course, a bare metal stent was implanted to seal the LAD artery dissection. The patient was discharged in a stable condition and was followed-up for rehabilitation. This case report underscores the multidisciplinary approach in facing challenges encountered after rare sequelae of chest trauma.

Traumatic Coronary Artery Dissection: A Case Report and Literature Review

Background: Coronary artery dissection after blunt chest trauma is a rare, life-threatening condition. Objectives: To present a case of coronary artery dissection after blunt chest trauma and to outline the appropriate management of this condition based on a literature review. Case Report: We report the case of a 50-year-old woman with traumatic coronary artery dissection after a high-speed motor vehicle collision. She presented to the Emergency Department via ambulance within a few hours of the collision, and her clinical condition deteriorated rapidly. A 12-lead electrocardiogram on arrival demonstrated anterolateral ST-segment elevation. The patient was intubated due to hypoxemic respiratory failure and she required inotropes for blood pressure support. Computed tomography imaging revealed pulmonary edema and right third and fourth rib fractures. Emergent angiography demonstrated dissection of her left main coronary artery, requiring placement of a stent. Conclusion: Early recognition of this clinical entity with a screening electrocardiogram, and aggressive management, may result in a favorable outcome. A literature review reveals that coronary artery bypass grafting, angiography with stent placement, and conservative management may all be considered viable treatment options for this condition.

Successful treatment of traumatic coronary artery dissection with angiographic stenting

Successful treatment of traumatic coronary artery dissection with angiographic stenting

Coronary artery dissection and acute myocardial infarction following blunt chest trauma

Blunt chest trauma might lead to cardiac injury ranging from simple arrhythmias to lethal conditions such as cardiac rupture. We experienced a case of initially overlooked traumatic coronary artery dissection which resulted in acute myocardial infarction (AMI). A high degree of suspicion is needed to diagnose this condition. Based on our case, we will give an overview of relevant literature on this topic. ECG, echocardiography, coronary angiography and cardiac enzymes are valuable tools in diagnosing this rare condition. The time span from coronary artery occlusion to revascularisation must be short if AMI is to be avoided.

Primary stenting for traumatic coronary artery dissection resulting from blunt chest Trauma—A Case Report

Traumatic coronary artery dissection is an extremely uncommon cause of myocardial infarction. We report a case of spontaneous coronary artery dissection in an 18-year-old previously healthy male caused by myocardial contusion. He was admitted to the hospital with a history of chest trauma and fracture of the radius and ulna bilaterally resulting from a motorcycle accident. The electrocardiograms, elevated creatine kinase, and cardiac troponins revealed acute anterior myocardial infarction. The transthoracic echocardiogram showed significant segmental wall motion abnormalities and moderate left ventricular systolic dysfunction. The coronary angiogram showed a traumatic dissection involving the proximal left anterior descending coronary artery. He underwent a dobutamine echocardiography “viability study” that revealed significant viable myocardium involving 50% of the left anterior descending coronary artery territory. He was treated by primary stent implantation (Cypher and regular stents) with an excellent result.

Primary stenting for traumatic coronary artery dissection resulting from blunt chest Trauma—A Case Report

Primary stenting for traumatic coronary artery dissection resulting from blunt chest Trauma—A Case Report

Traumatic coronary artery dissection

A 14-year-old boy sustained blunt chest trauma resulting in dissection of the left main coronary artery, postinfarction left ventricular aneurysm, mitral regurgitation, and tricuspid regurgitation. He underwent pericardial patch angioplasty of the left main coronary artery, left ventricular aneurysmectomy, mitral valvuloplasty, and tricuspid annuloplasty. The patient continues to do well 4 years after operation.