Studies have shown that cardiac ruptures due to blunt trauma are seen more often than expected. However, epicardial injuries and atrial ruptures are common findings in deaths due to falls. Our aim is to present a unique, isolated cardiac rupture in a 2 year-old child resulting from a fall from a bed, to evaluate autopsy findings among the literature from a medico-legal point of view.
Accidental Falls ; Child, Preschool ; Diagnosis, Differential ; Fatal Outcome ; Female ; Heart Injuries ; diagnosis ; etiology ; Heart Ventricles ; injuries ; Humans

Most patients diagnosed with takotsubo cardiomyopathies are expected to almost completely recover, and their prognosis is excellent. However, complications can occur in the acute phase. We present a case of a woman with takotsubo cardiomyopathy with right ventricular involvement who developed a rupture of the right ventricular free wall following ventricular septal rupture, as a consequence of an acute increase in right ventricular afterload by left-to-right shunt. Our case report illustrates that takotsubo cardiomyopathy can be life threatening in the acute phase. Ventricular septal rupture in biventricular takotsubo cardiomyopathy may be a harbinger of cardiac tamponade by right ventricular rupture.
Acute Disease ; Aged ; Female ; Heart Ventricles/injuries ; Humans ; Prognosis ; Takotsubo Cardiomyopathy/*complications ; Ventricular Septal Rupture/*etiology

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

BACKGROUND: Cardiac injuries are the most commonly overlooked injuries in patients who die from trauma. Patients who survive blunt cardiac rupture or penetrating injuries are rare and the incidence is not well defined. Many patients require urgent or emergency operations and operative mortality is very high. MATERIAL AND METHOD: A retrospective review of 26 patients with cardiac injuries due to thoracic trauma undergoing emergency thoracotomy from January 1997 to December 2005. RESULT: There were 17 male and 9 female patients, with a mean age of 45.3+/-16.2 (range: 17~80). Thirteen patients (50%) were injured in motor vehicle accidents, and five patients (19%) in motorcycle accidents. Six patients (23%) were injured by knives, and two patients (8%) were injured by falling. Anatomic injuries included right atrium (12 [46%]), left atrium (1 [4%]), right ventricle (5 [19%]), left ventricle (5 [19%]), and cardiac chambers (2 [7%]). Diagnosis was made by computer tomography in 12 patients and sonography in 14 patients. The average times from admission to operating room was 89.2+/-86.7 min (range: 10~335). The average time for diagnosis was 51.3+/-13.6 min (range: 5~280). The mean Revised Trauma Score (RTS) was 6.7+/-0.8, and the Glasgow Coma Scale (GCS), was 12.8+/-2.8. The overall mortality rate was 12% (3 out of 26 patients). CONCLUSION: The mortality rate from cardiac injury is very high. The survival rate can be increased only by a high index of suspicion, aggressive expeditious diagnostic evaluation, and prompt appropriate surgical management.
Diagnosis ; Emergencies ; Female ; Glasgow Coma Scale ; Heart Atria ; Heart Injuries ; Heart Rupture ; Heart Ventricles ; Humans ; Incidence ; Male ; Mortality ; Motor Vehicles ; Motorcycles ; Operating Rooms ; Retrospective Studies ; Survival Rate ; Thoracotomy

Here we report a case of posterior left ventricular (LV) free wall rupture following postinfarct ventricular septal rupture (VSR). A 58-year-old man was transferred to the hospital under the impression of acute myocardial infarction. Posterior VSR was seen on echocardiographic examination. The intraaortic balloon pump catheter was introduced percutaneously and the emergent operation was proposed. Sudden circulatory collapse was developed shortly after the anesthetic induction and the patient's chest was hurriedly opened while on cardiopulmonary resuscitation. The acute cardiac tamponade was seen and the blood was seen pumping from the longitudinal tear at the mid-level of LV posterior wall, measuring 2 cm in length. The cardiopulmonary bypass was set and LV reconstruction was done. The postoperative recovery was delayed due to the brain injury presumably caused by preoperative cardiac arrest.
Brain Injuries ; Cardiac Tamponade ; Cardiopulmonary Bypass ; Cardiopulmonary Resuscitation ; Catheters ; Echocardiography ; Heart Arrest ; Heart Septal Defects ; Heart Ventricles ; Humans ; Middle Aged ; Myocardial Infarction ; Rupture* ; Shock ; Thorax ; Ventricular Septal Rupture

A 64-year-old male patient underwent cardiac resynchronization therapy (CRT) device implantation via the axillary venous approach. Two weeks later, the patient started complaining of "electric shock-like" pain in the left axillary area. During physical examination, typical pain in the left axillary area was reproduced whenever his left shoulder was passively abducted more than 60 degrees. Fluoroscopic examination showed that the left ventricle (LV) and right atrium (RA) leads were positioned at an acute angle directing towards the left brachial plexus whenever the patient's shoulder was passively abducted. Brachial plexus irritation by the angulated CRT leads was strongly suspected. To relieve the acute angulation, we had to adjust the entry site of the LV and RA leads from the distal to the proximal axillary vein using the cut-down method. After successful lead repositioning, the neuropathic pain improved rapidly. Although transvenous pacing lead-induced nerve injury is not a frequent complication, this possibility should be kept in mind by the operators.
Axillary Vein ; Brachial Plexus* ; Cardiac Resynchronization Therapy ; Heart Atria ; Heart Ventricles ; Humans ; Male ; Middle Aged ; Neuralgia ; Peripheral Nerve Injuries ; Physical Examination ; Shoulder

BACKGROUND AND OBJECTIVES: Intense exercise (IE) induced myocardial fibrosis (MF) showed contradictory findings in human studies, making the relationship between IE and the development of MF unclear. This study aims to demonstrate exercise induced MF is associated with cardiac damage, and inflammation is essential to the development of exercise induced MF. METHODS: Sprague-Dawley rats were submitted to daily 60-minutes treadmill exercise sessions at vigorous or moderate intensity, with 8-, 12-, and 16-week durations; time-matched sedentary rats served as controls. Enzyme-linked immunosorbent assay (ELISA) was used to measure serum cardiac troponin I (cTnI) concentration. After completion of the exercise protocol rats were euthanized. Biventricular morphology, ultrastructure, and collagen deposition were then examined. Protein expression of interleukin (IL)-1β and monocyte chemotactic protein (MCP)-1 was evaluated in both ventricles. RESULTS: After IE, right but not left ventricle (LV) MF occurred. Serum cTnI levels increased and right ventricular damage was observed at the ultrastructure level in rats that were subjected to long-term IE. Leukocyte infiltration into the right ventricle (RV) rather than LV was observed after long-term IE. Long-term IE also increased protein expression of pro-inflammation factors including IL-1β and MCP-1 in the RV. CONCLUSIONS: Right ventricular damage induced by long-term IE is pathological and the following inflammatory response is essential to the development of exercise induced MF.
Animals ; Collagen ; Enzyme-Linked Immunosorbent Assay ; Fibrosis ; Heart Injuries ; Heart Ventricles ; Humans ; Inflammation ; Interleukins ; Leukocytes ; Monocytes ; Rats ; Rats, Sprague-Dawley ; Troponin I

Endomyocardial biopsy (EMBx) is a useful tool for diagnosing various cardiac pathologies. However, the routine use of EMBx has not gained widespread acceptance due to the possible complications related to the EMBx. Thus, not much information is available on the complications related to the EMBx. We prospectively evaluated 90 consecutive patients who underwent 2-D echocardiography guided transfemoral right ventricular EMBx at Kyungpook National University Hospital between March 2002 and November 2005 to determine the incidence, nature and subsequent management of complications related to EMBx. The clinical diagnoses before the EMBx were arrhythmogenic right ventricular dysplasia in 54, dilated cardiomyopathy in 19, Brugada syndrome in 9, myocarditis in 6 and miscellaneous in 2 patients. The overall major complication rate was 5.6% and no procedure-related mortality occurred. Myocardial perforation (n=3), which was the most frequent complication, did not progress to cardiac tamponade requiring pericardiocentesis in any patient. Hemodynamically unstable ventricular tachycardia occurred in 1 patient. New and persistent right bundle branch block occurred in another. Our findings suggest that 2-D echocardiography guided transfemoral right ventricular EMBx is a relatively safe procedure.
Wounds, Penetrating/*etiology/ultrasonography ; Treatment Outcome ; Surgery, Computer-Assisted/methods ; Middle Aged ; Male ; Humans ; Heart Ventricles/injuries/*pathology/*ultrasonography ; Heart Injuries/*etiology/ultrasonography ; Female ; Endocardium/injuries/pathology ; Echocardiography/methods ; Biopsy, Needle/*adverse effects ; Arrhythmia/*etiology/*ultrasonography

Endomyocardial biopsy (EMBx) is a useful tool for diagnosing various cardiac pathologies. However, the routine use of EMBx has not gained widespread acceptance due to the possible complications related to the EMBx. Thus, not much information is available on the complications related to the EMBx. We prospectively evaluated 90 consecutive patients who underwent 2-D echocardiography guided transfemoral right ventricular EMBx at Kyungpook National University Hospital between March 2002 and November 2005 to determine the incidence, nature and subsequent management of complications related to EMBx. The clinical diagnoses before the EMBx were arrhythmogenic right ventricular dysplasia in 54, dilated cardiomyopathy in 19, Brugada syndrome in 9, myocarditis in 6 and miscellaneous in 2 patients. The overall major complication rate was 5.6% and no procedure-related mortality occurred. Myocardial perforation (n=3), which was the most frequent complication, did not progress to cardiac tamponade requiring pericardiocentesis in any patient. Hemodynamically unstable ventricular tachycardia occurred in 1 patient. New and persistent right bundle branch block occurred in another. Our findings suggest that 2-D echocardiography guided transfemoral right ventricular EMBx is a relatively safe procedure.
Wounds, Penetrating/*etiology/ultrasonography ; Treatment Outcome ; Surgery, Computer-Assisted/methods ; Middle Aged ; Male ; Humans ; Heart Ventricles/injuries/*pathology/*ultrasonography ; Heart Injuries/*etiology/ultrasonography ; Female ; Endocardium/injuries/pathology ; Echocardiography/methods ; Biopsy, Needle/*adverse effects ; Arrhythmia/*etiology/*ultrasonography

Thirteen year old boy who had been stabbed in his left chest by the knife was transferred to our department from a general hospital, because of the massive bleeding from the intercostal tube drainage. Chest X-ray showed homogeneous density in the left lung field. He was confused and his vital signs were unstable. He was moved into a operating room as soon as possible. After resuscitation, his lacerated left ventricle wound was sutured through median sternotomy. The interventricular shunt was detected with intraoperative transesophageal echocardiography. The traumatic ventricular septal defect was closed via left ventricle using Dacron patch. His postoperative course was uneventful, and he was discharged with small residual shunt.
Drainage ; Echocardiography ; Echocardiography, Transesophageal ; Heart Septal Defects ; Heart Septal Defects, Ventricular* ; Heart Ventricles ; Hemorrhage ; Hospitals, General ; Humans ; Lung ; Male ; Operating Rooms ; Polyethylene Terephthalates ; Resuscitation ; Sternotomy ; Thoracic Injuries* ; Thorax* ; Vital Signs ; Wounds and Injuries