Successful management of penetrating chest injury causing aortopulmonary shunt

2019 ◽  
Vol 28 (2) ◽  
pp. 112-114
Author(s):  
Ravivarma Patil ◽  
Ameya Kaskar ◽  
Rahul Rao
Keyword(s):  
Computed Tomography ◽  
Cardiopulmonary Bypass ◽  
Main Pulmonary Artery ◽  
Penetrating Trauma ◽  
Cardioplegic Arrest ◽  
Successful Management ◽  
Direct Closure ◽  
Great Vessels ◽  
Patch Closure ◽  
Prosthetic Patch

Penetrating trauma to the chest causing an aortopulmonary shunt is rare. We report the case of a 16-year-old boy with an aortopulmonary shunt caused by a penetrating injury to the left anterior chest. Chest exploration was warranted because computed tomography confirmed a definite injury to the great vessels, causing a left-to-right shunt. The case was successfully managed with prosthetic patch closure of the aortic tear and direct closure of the rent in the main pulmonary artery under cardiopulmonary bypass with cardioplegic arrest.

Impact of cardiopulmonary bypass and cardioplegic arrest on myocardial lymphatic function

1995 ◽  
Vol 268 (1) ◽  
pp. H178-H183 ◽  
Author(s):  
U. Mehlhorn ◽  
K. L. Davis ◽  
E. J. Burke ◽  
D. Adams ◽  
G. A. Laine ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Myocardial Edema ◽  
Dry Weight ◽  
Myocardial Contraction ◽  
Left Ventricular ◽  
Lymph Flow ◽  
Cardioplegic Arrest ◽  
Lymphatic Function

Cardioplegic arrest (CPA) is associated with interstitial myocardial edema, which has been shown to impair myocardial function. The accumulation of interstitial myocardial edema may be enhanced by impaired myocardial lymph flow. The purpose of this study was to investigate the effects of CPA on myocardial lymphatic function. In nine anesthetized dogs, we cannulated a prenodal cardiac lymphatic and measured myocardial lymph flow rate (QL), myocardial lymph driving pressure (PL), and myocardial lymph hyaluronan (Hya) concentration. We determined left ventricular function using pressure-volume curves derived by sonomicrometry and micromanometry. The dogs were placed on cardiopulmonary bypass (CPB) (28 degrees C) and subjected to 60 min of hypothermic, crystalloid CPA. With the onset of asystole both QL and PL decreased significantly from 70.7 +/- 31.8 (SD) to 3.3 +/- 4.0 microliters/min and from 19.9 +/- 8.0 to 10.4 +/- 1.8 mmHg, respectively (P < 0.01). Following return of sinus rhythm after separation from CPB, QL and PL increased significantly to 135.4 +/- 28.0 microliters/min and 27.3 +/- 7.5 mmHg, respectively (P < 0.01). Post-CPA myocardial edema was demonstrated by gravimetric wet-to-dry weight determination of 3.67 +/- 0.20 (normal 2.90 +/- 0.20, P < 0.001) and was associated with significantly decreased left ventricular function. Myocardial Hya turnover rate was 1.3 +/- 1.0% per day under baseline conditions and increased significantly to 2.7 +/- 0.9% per day post-CPA (P < 0.01). We conclude that organized myocardial contraction is the major determinant of myocardial lymph flow. Myocardial lymph flow impairment during CPA may contribute to post-CPA myocardial edema and left ventricular dysfunction.

Results of using cardiopulmonary bypass for spinal cord protection during surgical repair of complex aortic coarctation

2013 ◽  
Vol 24 (1) ◽  
pp. 113-119 ◽  
Author(s):  
Stany Sandrio ◽  
Matthias Karck ◽  
Matthias Gorenflo ◽  
Tsvetomir Loukanov
Keyword(s):  
Spinal Cord ◽  
Cardiopulmonary Bypass ◽  
Aortic Arch ◽  
Aortic Coarctation ◽  
Mild Hypothermia ◽  
Circulatory Arrest ◽  
Main Pulmonary Artery ◽  
Neurologic Complication ◽  
Spinal Cord Protection ◽  
Age Range

AbstractBackgroundThe aim of this study was to evaluate the surgical treatment of complex aortic coarctation using partial cardiopulmonary bypass to increase the spinal cord protection.MethodsA total of 15 patients (age range from 7 to 48 years) underwent coarctation repair through a left posterolateral thoracotomy with cardiopulmonary bypass. Cannulation was performed via the descending aorta and the main pulmonary artery. In all, six surgeries were performed under hypothermic circulatory arrest and nine repairs were performed under mild hypothermia. The clinical outcome regarding the development of restenosis, as well as major neurologic complication, was studied.ResultsThere was no mortality. None of the patients developed paraplegia. Of the 15 patients, two developed a recurrent stenosis at the proximal anastomosis between the aortic arch and the aortic prothesis at a mean follow-up of 5.5 years. In the remaining 13 patients, echocardiography and magnetic resonance imaging showed no evidence of a significant gradient.ConclusionComplex aortic coarctation without hypoplasia of the proximal aortic arch and intra-cardiac anomalies can be repaired with low mortality and neurologic morbidity via a left thoracotomy using cardiopulmonary bypass. The use of cardiopulmonary bypass goes along with a low risk of spinal cord and lower body ischaemia and provides a sufficient amount of time for the anastomoses.

scholarly journals PENETRATING TRAUMA OF BRACHIOCEPHALIC ARTERY LESION WITH EMBOLIZATION OF FOREIGN BODY TO RIGHT AXILLARY ARTERY IN PEDIATRIC PATIENT: CASE PRESENTATION AND HIS MANAGEMENT.

2020 ◽  
Author(s):  
Luis Zerpa Acosta ◽  
Jameel Al Ata ◽  
Alfredo Sanchez Gamboa ◽  
Elmahi Babikir ◽  
Abdullah Al Zahrani ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Surgical Repair ◽  
Axillary Artery ◽  
Median Sternotomy ◽  
Penetrating Trauma ◽  
Innominate Artery ◽  
Penetrating Injuries ◽  
Patient Case ◽  
Case Presentation ◽  
Great Vessels

ABSTRACT: BACKGROUND: Penetrating injuries of the intrathoracic great vessels are well recognized although uncommon in pediatric patients, management in pediatric patients presents challenges. Surgical repair by median sternotomy is the exposure of choice for accessing innominate artery injuries, but endovascular intervention in being increasingly introduced in the hemodynamically stable

Congenital isolated absence of a single cusp of pulmonary valve

2021 ◽  
pp. 021849232110609
Author(s):  
Niraj Nirmal Pandey ◽  
Mumun Sinha ◽  
Arun Sharma ◽  
Ambuj Roy
Keyword(s):  
Computed Tomography ◽  
Pulmonary Valve ◽  
Heart Defects ◽  
Cardiac Computed Tomography ◽  
Main Pulmonary Artery ◽  
Pulmonary Regurgitation ◽  
Pulmonary Insufficiency ◽  
Cardiac Computed Tomography Angiography ◽  
Arterial Circulation ◽  
Pulmonary Arterial

A 25-year-old, previously asymptomatic female, presented to the outpatient clinic with episodic palpitations for past 6 months. She was acyanotic and showed no peripheral stigmata of infective endocarditis. Transthoracic echocardiography revealed dilated right ventricle with severe low-pressure pulmonary regurgitation. A cardiac computed tomography angiography performed for evaluation of pulmonary arterial circulation and intracardiac anatomy revealed isolated absence of posterior pulmonary cusp. The two other (right anterior and left anterior) cusps were normal and covered only part of the valve orifice, resulting in pulmonary insufficiency. The main pulmonary artery showed asymmetric dilatation. No other structural heart defects were noted.

Trauma Imaging

2020 ◽  
Author(s):  
Joel A. Gross ◽  
Martin L. Gunn ◽  
Kathleen R. Fink
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Cervical Spine ◽  
Magnetic Resonance ◽  
Penetrating Trauma ◽  
Organ Injury ◽  
Bladder Rupture ◽  
Subdural Hemorrhage ◽  
Solid Organ ◽  
Resonance Imaging

Due to increased use of computed tomography (CT) and ultrasonography, technological advances in equipment design, and increased availability of imaging equipment in the emergency department, imaging studies have revolutionized the assessment of the trauma patient in the past three decades. This review examines commonly used imaging modalities in trauma evaluation, initial and additional imaging, brief introduction to CT, and an overview of CT image processing and reviewing a CT scan. Head imaging, spine imaging, chest imaging, and abdominal and pelvic imaging are presented, along with injury grading, solid-organ injury appearances and specific abdominal solid-organ injuries, urinary system injury, penetrating trauma, unexplained intraperitoneal fluid, vascular injury and musculoskeletal injury. Figures show lateral view of the cervical spine; volume rendering of the pelvis; CT windows; CT imaging of acute intracranial bleeding, herniation in acute subdural hemorrhage, post-traumatic pseudoaneurysm of descending thoracic aorta, subscapular hematoma of the liver, liver laceration, pseudoaneurysm of the liver, shattered kidney and the nonperfused right kidney attributable to a traumatic renal artery injury, tigroid spleen, a focus of gas and stranding adjacent to the lateral wall of the ascending colon, extravasated urinary contrast (white material) surrounding the proximal right indicating ureteral laceration or transection, intraperitoneal bladder rupture, and contrast extravasation in the liver; magnetic resonance imaging versus CT of shear injuries; and magnetic resonance imaging in the setting of cervical spine trauma.  This review contains 18 highly rendered figures, 23 tables, and 83 references. Keywords:Trauma, computed tomography, radiography, magnetic resonance imaging, ultrasonography, imaging study

scholarly journals Noninvasive Demonstration of Dual Coronary Artery Fistulas to Main Pulmonary Artery with 64-Slice Multidetector-Computed Tomography: A Case Report

2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
Yoshiki Noda ◽  
Ryo Matsutera ◽  
Yoshinori Yasuoka ◽  
Haruhiko Abe ◽  
Hidenori Adachi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Coronary Artery ◽  
Pulmonary Artery ◽  
Multidetector Computed Tomography ◽  
Coronary Sinus ◽  
Transthoracic Echocardiography ◽  
Adult Population ◽  
Main Pulmonary Artery ◽  
Coronary Artery Fistulas

Coronary artery fistulas, including coronary pulmonary fistulas, are usually discovered accidently among the adult population when undergoing invasive coronary angiographies. We report here a 58-year-old woman with dual fistulas originating from the left anterior descending coronary artery and right coronary sinus to the main pulmonary artery, demonstrating noninvasively with multidetector-computed tomography (MDCT) and transthoracic echocardiography (TTE).

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