Electric shock-induced cardiac injuries requiring surgical intervention: Case series and a brief review.
- 作者列表："Jacob S","Landolfo KP","El-Sayed Ahmed MM","Thomas M","Makey IA","Pham SM
BACKGROUND:Electric shock-induced cardiac injuries, such as myocardial infarction, thrombosis, and dissection, are rare. Few cases have been previously reported. The right coronary artery is most often affected because of its proximity to the chest wall. AIMS:To study the extend of electrical injuries on cardiac tissues and its surgical management. MATERIALS AND METHODS:We conducted a retrospective study on our patients in the last five years, looking for cardiac electrical injuries treated surgically in our department, we identified three cases. RESULT:Our three-case series, reported herein, showed that multiple cardiac tissues are susceptible to electrical injuries, specifically the left coronary artery, inferior vena cava, and right ventricular free wall. In our series, the first patient was a 32-year-old man with triple vessel thrombosis and dissection who survived the electric shock. The second patient was a 23-year-old man who had an inferior vena cava burn and bruising; his heart was used for transplantation. After the transplant, the recipient had a left coronary artery dissection and underwent coronary artery bypass grafting. The third patient was a 30-year-old man (potential heart donor) who had a hematoma of the right ventricular free wall, possible coronary artery dissection, inferior vena cava bruising, and tissue damage. His heart was not used for transplant because of quality concerns. CONCLUSION:We recommend that any person who sustains high voltage (500 V or more) electric shock should be evaluated carefully in the emergency department, including with echocardiography and cardiac catheterization, if indicated, to determine the extent of the injury and the viability of the heart, for patients who do not survive as a donor organ.
背景休克引起的心脏损伤，如心肌梗死、血栓形成和夹层，是罕见的。以前报告的病例很少。右冠状动脉最常受到影响，因为它靠近胸壁。 目的: 探讨电损伤对心脏组织的影响及外科治疗。 材料和方法: 我们对过去五年的患者进行了回顾性研究，寻找在我科手术治疗的心脏电击伤，我们确定了3例病例。 结果: 本文报告的三个病例系列显示，多个心脏组织易受电击伤，特别是左冠状动脉、下腔静脉和右心室游离壁。在我们的系列中，第一例患者是一名患有三血管血栓形成和夹层的32岁男性，他在电击中幸存下来。第二名患者是一名23岁的男子，他患有下腔静脉烧伤和瘀伤; 他的心脏用于移植。移植后，受体出现左冠状动脉夹层，并接受了冠状动脉旁路移植术。第三名患者是一名30岁的男性 (潜在的心脏捐献者)，他有右心室游离壁血肿、冠状动脉夹层可能、下腔静脉淤血和组织损伤。由于质量问题，他的心脏没有用于移植。 结论: 我们建议任何承受高压 (500伏或更高) 电击的人应在急诊科仔细评估，包括超声心动图和心导管插入术 (如果有指示)，以确定损伤程度和心脏活力，对于不能作为供体器官存活的患者。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.