The study introduced a first survival case of cardiac rupture due to trauma operated in Viet Tiep Hospital. The patient was admitted to hospital by the initial diagnosis of shock, cranial trauma, and thoracic trauma. He immediately operated because of cardiac rupture. The examination after one month, one year demonstrated the perception and cardiovascular function were normal. The study also suggested some methods for operation of cardiac rupture, including incision along the xiphoid bone for cases with cardiac press, thoracic open in the side of apoplexy for cases of shock due to blood loss and pleural apoplexy. cardiac sock
Heart Rupture, Wounds and Injuries

Adolescent ; Heart Ventricles ; injuries ; Humans ; Male ; Thoracic Injuries ; complications ; Ultrasonography ; Ventricular Septal Rupture ; diagnostic imaging ; etiology ; surgery ; Wounds, Nonpenetrating ; complications

Accidents, Traffic ; Adult ; Heart Injuries ; complications ; etiology ; pathology ; Hernia ; etiology ; pathology ; Humans ; Male ; Pericardium ; injuries ; Rupture ; Wounds, Nonpenetrating ; complications

Traumatic ventricular septal defect (VSD) resulting from blunt chest injury is a very rare event. The mechanisms of traumatic VSD have been of little concern to dateuntil now, but two dominant theories have been described. In one, the rupture occurs due to acute compression of the heart; in the other, it is due to myocardial infarction of the septum. The clinical symptoms and timing of presentation are variable, so appropriate diagnosis can be difficult or delayed. Closure of traumatic VSD has been based on a combination of heart failure symptoms, hemodynamics, and defect size. Here, we present a case of a 4-year-old boy who presented with a traumatic VSD following a car accident. He showed normal cardiac structure at the time of injury, but after 8 days, his repeated echocardiography revealed a VSD. He was successfully treated by surgical closure of the VSD, and has been doing well up to the present. This report suggests that the clinician should pay great close attention to the patients injured by blunt chest trauma, keeping in mind the possibility of cardiac injury.
Child ; Echocardiography ; Heart Failure ; Heart Septal Defects, Ventricular ; Hemodynamics ; Humans ; Myocardial Infarction ; Preschool Child ; Rupture ; Thoracic Injuries ; Thorax ; Wounds, Nonpenetrating

Blunt chest trauma may cause a variety of cardiac injuries, such as cardiac contusion, congestive heart failure due to myocardial injury or disruption of intracardiac structures, and more severely, instantaneous death. Traumatic rupture of the interventricular septum secondary to blunt chest trauma is extremely rare. Rupture of the interventricular septum may occur almost immediately after injury or many days later. The most common site of rupture is in the muscular portion of the septum near the apex. The exact mechanism of ventricular septal rupture in blunt trauma is unknown but it is thought to occur by external compression of the heart between the sternum and the vertebrae or as a result of extreme changes in intrathoracic pressure during sudden deceleration. We report an autopsy case of intraventricular septum rupture due to blunt chest trauma. A comatous 28-year-old male was admitted to emergency room after blunt chest trauma by unidentified object. He was treated with supportive care but expired two days later. The autopsy findings were as follows. The dead boy was slightly slender. External wound and patterned bruise were not present. In submentopubic incision, both pleural fluid (right 700ml, left 450ml) and ascites (400ml) were noted. The posterior wall of left ventricle showed hemorrhage measuring 1cm in diameter. On opening the heart, there was interventricular septum rupture measuring 3.5cm in length. Other cardiac structures were unremarkable. On light microscopic examination, endothelial cell was not seen in ruptured portion and both lung showed severe congestion and edema.
Adult ; Ascites ; Autopsy ; Contusions ; Deceleration ; Edema ; Emergency Service, Hospital ; Endothelial Cells ; Estrogens, Conjugated (USP) ; Heart ; Heart Failure ; Heart Ventricles ; Hemorrhage ; Humans ; Lung ; Male ; Rupture* ; Spine ; Sternum ; Thorax* ; Ventricular Septal Rupture ; Wounds and Injuries

Blunt chest trauma may cause a variety of cardiac injuries, such as cardiac contusion, congestive heart failure due to myocardial injury or disruption of intracardiac structures, and more severely, instantaneous death. Traumatic rupture of the interventricular septum secondary to blunt chest trauma is extremely rare. Rupture of the interventricular septum may occur almost immediately after injury or many days later. The most common site of rupture is in the muscular portion of the septum near the apex. The exact mechanism of ventricular septal rupture in blunt trauma is unknown but it is thought to occur by external compression of the heart between the sternum and the vertebrae or as a result of extreme changes in intrathoracic pressure during sudden deceleration. We report an autopsy case of intraventricular septum rupture due to blunt chest trauma. A comatous 28-year-old male was admitted to emergency room after blunt chest trauma by unidentified object. He was treated with supportive care but expired two days later. The autopsy findings were as follows. The dead boy was slightly slender. External wound and patterned bruise were not present. In submentopubic incision, both pleural fluid (right 700ml, left 450ml) and ascites (400ml) were noted. The posterior wall of left ventricle showed hemorrhage measuring 1cm in diameter. On opening the heart, there was interventricular septum rupture measuring 3.5cm in length. Other cardiac structures were unremarkable. On light microscopic examination, endothelial cell was not seen in ruptured portion and both lung showed severe congestion and edema.
Adult ; Ascites ; Autopsy ; Contusions ; Deceleration ; Edema ; Emergency Service, Hospital ; Endothelial Cells ; Estrogens, Conjugated (USP) ; Heart ; Heart Failure ; Heart Ventricles ; Hemorrhage ; Humans ; Lung ; Male ; Rupture* ; Spine ; Sternum ; Thorax* ; Ventricular Septal Rupture ; Wounds and Injuries

After a penetrating thoracic injury early detection of intracardiac injury and early surgical repair when indicated are essential. A case presenting severe respiratory distress two weeks after a penetrating thoracic injury is reported. Transesophageal echocardiography showed massive pericardial effusion ventricular septal defect and mirtal regurgitation, The infundibular ventricular septal perforation was repaired using a Dacron patch the anterior mitral leaflet by interrupted sutures and the ruptured chordae of the posterior leaflet by a new chordae formation.
Echocardiography, Transesophageal ; Heart Septal Defects, Ventricular* ; Mitral Valve Insufficiency* ; Pericardial Effusion ; Polyethylene Terephthalates ; Sutures ; Thoracic Injuries ; Ventricular Septal Rupture ; Wounds, Penetrating

TOF is a congenital cyanotic heart disease which has severe physiodynamic changes in the cardiovascular system. The anesthesiologist should be able to manage the anesthesia for open heart surgery, be aware of the operation procedure, and have knowledge and experience to cope with the unpredictable changes of the patient's condition during operation. One hundred open heart anesthesias have been performed in BNUH from July 1981 to August 1983, of which 17 cases of anesthesia for total correction of TOF were analyzed and the following results were obtained. 1) It was difficult to predict the prognosis for the patient after open heart anesthesia by the chest X-ray, echocardiogram or electrocardiogram. 2) Anesthesia were performed by the combination of halothane-N2O0morphine as the main anesthetic agents. 3) Postoperative complication were wound infection(4 cases, 14.3%), arrhythmia(3 cases, 10.7%), low cardiac output syndrome(3 cases, 10.7%) and cardiac arrest (3 cases, 10.7%). 4) In 7 cases of death, the causes of death were low cardiac output syndrome(3 cases, 43.9%), heart failure (2 cases, 28.5%), renal failure (1 case, 14.3%) and aneurysmal rupture (1case, 14.3%).
Anesthesia* ; Anesthetics ; Aneurysm ; Cardiac Output, Low ; Cardiovascular System ; Cause of Death ; Electrocardiography ; Heart ; Heart Arrest ; Heart Diseases ; Heart Failure ; Humans ; Postoperative Complications ; Prognosis ; Renal Insufficiency ; Rupture ; Thoracic Surgery ; Thorax ; Wounds and Injuries

BACKGROUND: Minimally invasive technique for various cardiac surgeries has become widely accepted since it has been proven to have distinct advantages for the patients. We describe here the results of our experiences of minimal incision in cardiac surgery. MATERIAL AND METHOD: From February 1997 to November 1998, we successfully performed 31 cases of minimally invasive cardiac surgery. Male and female ratio was 17:14, and the patients age ranged from 1 to 75 years. A left parasternal incision was used in 9 patients with single vessel coronary heart disease. A direct coronary bypass grafting was done under the condition of the beating heart without cardiopulmonary bypass support(MIDCAB). Among these, one was a case of a reoperation 1 week after the first operation due to a kinked mammary artery graft. A right parasternal incision was used in one case of a redo mitral valve replacement. Mini-sternotomy was used in the remaining 21 patients. The procedures were mitral valve replacement and tricuspid annuloplasty in 6 patients, mitral valve replacement 5, double valve replacement 2, aortic valve replacement 1, removal of left atrial myxoma 1, closure of atrial septal defect 2, repair of ventricular septal defect 2, and primary closure of r ght ventricular stab wound 1. The initial 5 cases underwent a T-shaped mini-sternotomy, however, we adopted an arrow-shaped ministernotomy in the remaining cases because it provided better exposure of the aortic root and stability of the sternum after a sternal wiring. RESULT: The operation time, the cardiopulmonary bypass time, the aorta cross-clamping time, the mechanical ventilation time, the amount of chest tube drainage until POD#1, the chest tube indwelling time, and the duration of intensive care unit staying were in an acceptable range. There were two surgical mortalities. One was due to a rupture of the aorta cannulation site after double valve replacement on POD#1 in the mini-sternotomy case, and the other was due to a sudden ventricular arrhythmia after MIDCAB on POD#2 in the parasternal incision case. Postoperative complications were observed in 2 cases in which a cerebral embolism developed on POD#2 after a mini-sternotomy in mitral valve replacement and wound hematoma developed after a right parasternal incision in a single coronary bypass grafting. Neither mortality nor complication was directly related to the incision technique itself. CONCLUSION: Minimally invasive surgery using parasternal or mini-sternotomy incision can be used in cardiac surgeries since it is as safe as the standard full sternotomy incisions.
Aorta ; Aortic Valve ; Arrhythmias, Cardiac ; Cardiopulmonary Bypass ; Catheterization ; Chest Tubes ; Coronary Disease ; Drainage ; Female ; Heart ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Hematoma ; Humans ; Intensive Care Units ; Intracranial Embolism ; Male ; Mammary Arteries ; Mitral Valve ; Mortality ; Myxoma ; Postoperative Complications ; Reoperation ; Respiration, Artificial ; Rupture ; Sternotomy ; Sternum ; Surgical Procedures, Minimally Invasive ; Thoracic Surgery* ; Transplants ; Wounds and Injuries ; Wounds, Stab

Aortic dissection may be considered the result of a discrepancy between the strength of the aortic wall and the intramural pressure. And factors that predispose to aortic dissection may include systemic hypertension, cystic medial necrosis, Marfan's syndrome, atherosclerosis, disease of aortic valve, pregnancy, giant cell arteritis, hyperthyrosis, disease of aortic valve, pregnancy, giant cell arteritis, hyperthyroidism, and blunt chest trauma. A few of aortic dissection may extend retrograde toward the aortic valve and involve the coronary arteries. Coronary artery occlusions due to mural dissection are an uncommon but well documented cause of myocardial infarction. Although rare, extramural hematoma compressing the coronary artery is another cause of myocardial infarction. At autopsy of 43 years old male who had no critical external wound, pericardial sac was distended and contained 400ml of dark red and clotted blood. Examination of the aorta revealed only minute atherosclerosis, intact aortic valve, and patent coronary ostia. 0.5cm sized aortic rupture was noted at the 3.5cm distal to the aortic valve. DeBakey type II aortic dissection was found to involve the ascending aorta and brachiocephalic trunk. Three intimal tears were 1.5cm, 8cm. 11.5cm distal to the aortic valve and two false lumens which had intact area between them extended 3.5cm distal to the third intimal tear and proximally in a retrograde fashion to the aortic root. Microscopically, sections of aorta showed relatively intact arrangement of smooth muscle and elastic fibers, except mild vascular ectasia and scattered several foci of the small sized aggregation of foamy histiocytes, and there was no evidence of cystic medial degeneration in aorta. Sections of both coronary arteries did not show mural dissection or atherosclerosis. Sections of right atrium and sinus node showed inflammatory reaction, extensive replacement of myocardium by active fibrous tissue consistent with infarction. There was no histologic evidence of myocardial infarction in the walls of other chambers or septum of the heart. We believe that extramural compression of the artery to sinus m\node by the dissecting hematoma was the cause of myocardial infarction involving the right atrium and the sinus node.
Adult ; Aorta ; Aortic Rupture ; Aortic Valve ; Arteries ; Atherosclerosis ; Autopsy ; Brachiocephalic Trunk ; Coronary Vessels ; Dilatation, Pathologic ; Elastic Tissue ; Giant Cell Arteritis ; Heart ; Heart Atria ; Hematoma ; Hemodynamics* ; Histiocytes ; Humans ; Hypertension ; Hyperthyroidism ; Infarction ; Male ; Marfan Syndrome ; Muscle, Smooth ; Myocardial Infarction* ; Myocardium ; Necrosis ; Pregnancy ; Sinoatrial Node ; Thorax ; Wounds and Injuries