It is estimated that 15% of traffic accidents cause trauma to large vessels. In about 70%-95% of cases, aortic rupture took place in the distal ligament of the left subclavian artery, whereas in the remaining cases rupture occurred in the ascending aorta above the aortic valve. Trauma to the aortic sinus and coronary arteries is rarely found in traffic accident victims. Therefore, coronary artery trauma is often misdiagnosed as coronary atherosclerotic heart disease. The present case is a 42 years old male who survived from a traffic accident. He presented with aortic sinus and left coronary artery trauma. He was misdiagnosed as having coronary atherosclerotic heart disease, and therefore wrongly given antiplatelet medicine, such as aspirin, in another hospital. Definite diagnosis was achieved in our hospital, and the patient underwent Bentall and mitral valve replacement, as well as tricuspid valvuloplasty. The aortic occlusion time during surgery was 47 min, and the total cardiopulmonary bypass time was 63 min. After surgery, transthoracic echocardiography confirmed that all the artificial valves worked sufficiently. The patient felt good and symptoms such as asthma and decreased exercise tolerance disappeared. This case taught us that acute aortic syndrome cannot be ignored when patients present with pectoralgia; antiplatelet medication should not be given before definite diagnosis.
Adult ; Coronary Artery Disease ; diagnosis ; Coronary Vessels ; injuries ; Diagnostic Errors ; Humans ; Male ; Sinus of Valsalva ; injuries

Adult ; Aneurysm, Dissecting ; diagnosis ; etiology ; Computed Tomography Angiography ; methods ; Conservative Treatment ; methods ; Coronary Angiography ; methods ; Coronary Vessels ; diagnostic imaging ; pathology ; Electrocardiography ; methods ; Heart Injuries ; complications ; Humans ; Magnetic Resonance Imaging, Cine ; methods ; Male ; Multimodal Imaging ; methods ; Myocardial Infarction ; diagnosis ; etiology ; therapy ; Treatment Outcome ; Wounds, Nonpenetrating ; complications

PURPOSE: Kawasaki disease (KD) is an immune-related multisystemic vasculitis that occurs in children, especially ensuing from a coronary artery abnormality. Sodium level is known to be related to vascular injury, which could affect the progress of KD. The purpose of this study was to determine the serum sodium levels that could predict the occurrence of cardiac and coronary artery events in KD. METHODS: We conducted a retrospective review of medical records for 104 patients with KD from January 2015 to December 2015. Patients with serum Na levels of <135 mEq/L at the time of initial diagnosis were assigned to the hyponatremia group. Laboratory findings and echocardiographic data were analyzed for various aspects. RESULTS: Among the 104 patients with KD, 91 were included in the study, of whom 48 (52.7%) had hyponatremia. The degree of fever, white blood cell count, percentage of neutrophils, percentage of lymphocytes, total bilirubin level, brain natriuretic peptide level, erythrocyte sedimentation rate, and C-reactive protein level were higher in the patients with hyponatremia. They also demonstrated a trend of larger coronary artery diameters based on Z scores. CONCLUSION: The severity of vascular inflammation in acute KD with hyponatremia might worsen the prognosis of coronary vasculature. Although no statistically significant correlation was found between the initial serum sodium levels and coronary arteriopathy in the patients with KD in this study, a long-term follow-up study with a larger number of enrolled patients should be designed in the future to elucidate the relationship between serum sodium level and coronary arteriopathy in patients with KD.
Bilirubin ; Blood Sedimentation ; C-Reactive Protein ; Child ; Coronary Vessels* ; Diagnosis ; Echocardiography ; Fever ; Follow-Up Studies ; Humans ; Hyponatremia ; Inflammation ; Leukocyte Count ; Lymphocytes ; Medical Records ; Mucocutaneous Lymph Node Syndrome* ; Natriuretic Peptide, Brain ; Neutrophils ; Prognosis ; Retrospective Studies ; Sodium* ; Vascular System Injuries ; Vasculitis

BACKGROUND: There are several modalities of coronary artery revascularization for multivessel coronary artery disease. Hybrid coronary revascularization (HCR) with minimally invasive direct coronary artery bypass grafting was introduced for high-risk patients, and recently, many centers have been using it. Limited incisional full sternotomy coronary artery bypass (LIFCAB) involves left internal thoracic artery (LITA)-to-left anterior descending coronary artery (LAD) anastomosis through a sternotomy with a minimal skin incision; it could be considered another technique for minimally invasive LITA-to-LAD anastomosis. Our center has performed HCR using LIFCAB, and in this paper, we report our short-term results, obtained in the past 3 years. METHODS: The medical records of 38 patients from May 2010 to June 2013 were analyzed retrospectively. The observation period after HCR was 1 to 37 months (average, 18.3+/-10.3 months). The patency of revascularization was confirmed with postoperative coronary angio-computerized tomography or coronary angiography. RESULTS: There were 3 superficial wound complications, but no mortalities. All the LITA-to-LAD anastomoses were patent in the immediate postoperative and follow-up studies, but stenosis was detected in 3 cases of percutaneous coronary intervention. CONCLUSION: HCR using LIFCAB is safe and yields satisfactory results from the viewpoint of revascularization for multivessel disease.
Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Bypass* ; Coronary Artery Disease ; Coronary Vessels* ; Follow-Up Studies ; Humans ; Mammary Arteries ; Medical Records ; Mortality ; Myocardial Revascularization ; Percutaneous Coronary Intervention ; Retrospective Studies ; Skin ; Sternotomy* ; Surgical Procedures, Minimally Invasive ; Wounds and Injuries

Adult ; Aneurysm, Dissecting ; diagnosis ; physiopathology ; Aneurysm, False ; Coronary Aneurysm ; diagnosis ; physiopathology ; Coronary Vessels ; pathology ; physiopathology ; Humans ; Male ; Myocardial Infarction ; diagnosis ; physiopathology ; Thoracic Injuries ; complications ; physiopathology ; Young Adult

Coronary artery injury after thoracic injury is very rare, but can result in serious acute myocardial infarction (MI). It can be easily mistaken for chest wall pain or cardiac contusion if relying solely on a history and physical examination. We herein report a rare case of a 60-year-old female patient who presented with inferior wall ST-segment elevation MI due to right coronary artery dissection following blunt chest trauma after a traffic accident. Successful primary percutaneous coronary intervention was performed without complications.
Accidents, Traffic ; Contusions ; Coronary Vessels ; Female ; Humans ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Physical Examination ; Thoracic Injuries ; Thoracic Wall ; Thorax

We report a case of 62-year-old man with cardiac tamponade due to coronary artery injury after acupuncture into the substernum. After resuscitation of cardiac arrest, we performed emergent pericardiocentesis. Nevertheless, the cardiac arrest recurred, and the emergent operation on cardiopulmonary bypass was performed. We identified hemopericardium due to shredded acute marginal branch of right coronary artery, and it was ligated leading to termination of bleeding. The patient was discharged without any other complications.
Acupuncture Therapy/*adverse effects ; Cardiac Tamponade/*diagnosis/etiology ; Coronary Vessels/*injuries ; Humans ; Male ; Middle Aged ; Pericardial Effusion/*diagnosis/etiology

Adult ; Aneurysm, False ; complications ; diagnosis ; Coronary Aneurysm ; complications ; diagnosis ; Coronary Angiography ; methods ; Coronary Vessels ; injuries ; Humans ; Male ; Myocardial Infarction ; etiology ; Tomography, X-Ray Computed ; methods ; Ultrasonography, Interventional ; methods

Aged ; Angioplasty, Balloon, Coronary ; adverse effects ; Coronary Vessels ; injuries ; Drug-Eluting Stents ; Humans ; Male ; Polytetrafluoroethylene ; chemistry ; therapeutic use

BACKGROUND: There has been an increase in the number of elderly patients considered for coronary artery bypass grafting (CABG). Recently, there were many satisfactory reports of coronary artery bypass grafting (CABG) in old age due to the development in operative technique and postoperative management. We evaluated operative and follow-up results of patients 70 years of age and older compared to 60 years old. MATERIAL AND METHOD: We retrospectively studied the cases of 74 consecutive patients 70 years or older (group A) who underwent a elective CABG from January 2000 to December 2003 and compared that of relatively young age group (group B, 60-69 years old). We compared preoperative characteristics, operation technique, postoperative results that effect outcome, also we investigated late mortality and cardiac events at follow-up periods. RESULT: Preoperative demographic and clinical characteristics of two groups were not different, except preoperative renal dysfunction(serum creatinine: > or= 1.4 mg/dl) (group A 17, 23% vs group B 14, 9%) (p=0.024). There was no difference of the mean number of distal anastomosis and the left ventricular ejection fraction in group A decreased significantly from 53.7+/-13% preoperatively to 49.9+/-12% postoperatively (p=0.02), but not changed in group B. There was no difference at operative mortality rate and postoperative major morbidity rate, but wound problem of saphenous vein harvest site was significantly higher in group A than group B (6.8% vs 0.7%, p=0.02). The mean follow up duration was 24.3+/-13 months and the cumulative survival were 95.4% at 2 year and 79.9% at 4 year in group A and 95.4% at 2 year and 90.1% at 4 year in group B (p=ns). CONCLUSION: We conclude that age is not a factor of determination when we decide about operation because coronary artery bypass grafting in elderly more than 70 years old can be performed with a low mortality rate and acceptable morbidity rate.
Age Factors ; Aged ; Coronary Artery Bypass* ; Coronary Vessels* ; Creatinine ; Follow-Up Studies ; Humans ; Middle Aged ; Mortality ; Retrospective Studies ; Saphenous Vein ; Stroke Volume ; Wounds and Injuries