A 28-year old man developed transmural anterior wall myocardial infarction after a car accident despite the absence of external signs of chest trauma. Coronary angiography one month after the accident demonstrated an aneurysm of the left anterior descending artery. Angiography five and eleven months afterwards showed almost total regression of the aneurysm. The man remained asymptomatic with no signs of residual ischaemia one year after the accident. Blunt trauma to the chest is a well-known cause of cardiac damage including myocardial contusion, rupture of the ventricular wall, septum, papillary muscles or chordae tendineae. Myocardial infarction secondary to distinct injury to a coronary artery has only seldom been described. Visualization of a localized lesion in a coronary artery of an otherwise non-atherosclerotic coronary tree supports the traumatic origin of a myocardial infarction.

A postoperative follow-up study of 21 cases of discrete membranous subvalvular aortic stenosis is presented. The age at operation was 6-47 (mean 16) years, and the follow-up time 0.6-16 (mean 6.7) years. Preoperatively most patients were in NYHA function class II or III and had high peak systolic pressure gradient, left ventricular hypertrophy and/or cardiothoracic index greater than 0.50. At follow-up all but six patients were in NYHA class I, the Doppler-estimated peak systolic gradient was 0-36 (mean 18) mmHg, the cardiothoracic index unchanged and the mean left ventricular hypertrophy score had declined from 4.3 to 2.3. Of 13 patients without aortic regurgitation preoperatively, eight had regurgitation at follow-up (group I) and five did not (group II). The interval to follow-up was significantly longer and the preoperative peak systolic gradient was greater in group I than in group II. Aortic regurgitation may develop even after surgical relief of discrete membranous subvalvular aortic stenosis, possibly associated with high preoperative pressure gradient and time from operation. Regular postoperative Doppler echocardiography is therefore recommended.