Severe Tricuspid Regurgitation and Atrioventicular Block Caused by Blunt Thoracic Trauma in an Elderly Woman

Hasdemir, Hakan; Arslan, Yucesin; Alper, Ahmet Taha; Osmonov, Damirbek; Güvenç, Tolga Sinan; Poyraz, Esra; Akyüz, Şükrü; Yıldız, Mustafa

doi:10.1016/j.jemermed.2010.05.069

Cited by 15 publications

(8 citation statements)

References 6 publications

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“…Interestingly, in the present study, the pigs of both RIA groups showed valvular insufficiencies of the mitral valve, the pulmonary valve as well as of the tricuspid valve 6 hours after experimental multiple trauma. Valvular disruptions and valvular lesions are frequently recorded after road accidents 28‐30 . More importantly, valvular ruptures are associated with blunt cardiac injuries, resulting in severe hemodynamically sequelae and in cardiopulmonary diseases.…”

Section: Discussionmentioning

confidence: 99%

Reaming of femoral fractures with different reaming irrigator aspirator systems shows distinct effects on cardiac function after experimental polytrauma

Lackner

Weber

Miclau

et al. 2020

Journal Orthopaedic Research

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Cardiac injuries are recorded after multiple trauma and are associated with a poor patient outcome. Reaming prior to locked intramedullary nailing is a frequently used technique to stabilize femoral diaphysis fractures. However, in polytraumatized patients, complications such as fat emboli and acute respiratory distress syndrome have been associated with reaming. The reaming irrigator aspirator (RIA) system provides concomitant irrigation and suction of the intramedullary contents, and should, therefore, reduce reaming‐associated complications. The aim of the study was to investigate cardiac function after multiple trauma with regard to two different RIA devices (RIAI vs RIAII). 15 male pigs were included in the study. Pigs received either sham treatment or multiple trauma (chest trauma, femur fracture, liver laceration, and hemorrhagic shock), followed by intramedullary nailing after reaming with either the RIAI or RIAII system (RIAII: reduced diameter of the reamer, improved control of irrigation and suction). Cardiac function was assessed by transesophageal echocardiography and systemic inflammation as well as local cardiac damage examined. Pigs of both treatment groups showed impaired cardiac function, valvular insufficiency, and cardiac damage. Systemic inflammation and local cardiac alterations were observed which might contribute to early myocardial damage in vivo. Multiple trauma including long‐bone fracture and subsequent intramedullary reaming induces cardiac dysfunction and valvular insufficiency, which might be linked to both mechanical cardiac injury and increased systemic inflammation. 6 hours after trauma there are less differences between RIAI and RIAII treatment with regard to post‐traumatic cardiac consequences in multiple injured pigs, indicating no beneficial effect of RIAII over RIAI.

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Section: Discussionmentioning

confidence: 99%

Reaming of femoral fractures with different reaming irrigator aspirator systems shows distinct effects on cardiac function after experimental polytrauma

Lackner

Weber

Miclau

et al. 2020

Journal Orthopaedic Research

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show abstract

“…The literature describes that traumatic rupture of the chordae tendineae leads to acute severe mitral regurgitation, in case of motor vehicle accidents 27 . Furthermore, different case reports described trauma associated with severe tricuspid regurgitation 28,29 . However, published case reports of traumatic valvular damage vary widely on observed symptoms: patients are described to be asymptomatic for years or become hemodynamic instable directly after trauma.…”

Section: Discussionmentioning

confidence: 99%

Early myocardial damage (EMD) and valvular insufficiency result in impaired cardiac function after multiple trauma in pigs

Weber

Lackner

Baur

et al. 2021

Sci Rep

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One third of multiple trauma patients present abnormal echocardiographic (ECHO) findings. Therefore, ECHO diagnostic after trauma is indicated in case of hemodynamic instability, shock, after chest trauma and after cardiac arrest. 20 male pigs underwent multiple trauma. Blood samples were collected 4 and 6 h after trauma and concentrations of heart-type fatty acid binding protein (HFABP) as a biomarker for EMD were measured. Myocardial damage was evaluated by scoring Hematoxylin–Eosin stained sections. At baseline, 3 and 6 h after trauma, transesophageal ECHO (TOE) was performed, invasive arterial and left ventricular blood pressure were measured to evaluate the cardiac function after multiple trauma. Systemic HFABP concentrations were elevated, furthermore heart injury score in multiple trauma animals was increased determining EMD. A significant decrease of blood pressure in combination with a consecutive rise of heart frequency was observed. Ongoing depression of mean arterial pressure and diastolic blood pressure were accompanied by changes in ECHO-parameters indicating diastolic and systolic dysfunction. Furthermore, a valvular dysfunction was detected. In this study complex myocardial and valvular impairment after multiple trauma in pigs has been observed. Therefore, detection of EMD and progressive valvular dysfunction might be crucial and therapeutically relevant.

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“…[21] Electrophysiological and structural abnormalities, promoting abnormal impulse formation and propagation, lead to dysrhythmias. [22] And transient dysrhythmias may be observed caused by cardiac contusion after blunt chest trauma, such as mechanical or electrical dysfunction including high degree atrioventricular block and ventricular fibrillation, the mechanism is that ionic channels alterations and its effect on cardiac depolarization and subsequently cardiac death. [23,24] However, rare clinical cases in the literature confirm that blunt chest trauma can cause conduction defects.…”

Section: Discussionmentioning

confidence: 99%

Sudden death due to the atrioventricular node contusion

Zhang²,

Liang³

et al. 2017

Medicine

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Introduction:Atrioventricular node (AVN) contusion usually results in cardiogenic shock and arrhythmia and is a rare but fatal condition. The condition is difficult to diagnose and easily overlooked because it develops rapidly and is asymptomatic. We here report 3 cases that demonstrate blunt chest impact and hemorrhages of the posterior atrioventricular junction, eventually result in death.Clinical Findings:Autopsy and histological examination were performed on all cases. External inspection revealed bruises in the hearts and fractures in the sternum and ribs. However, histological examinations were conclusive and showed cardiac contusion on the surface of the posterior atrioventricular junction of the individuals, and the death was due to the AVN contusion. The position of the AVN on the heart surface is determined by detailed examinations via an autopsy and microscopic, both of which are critical in the certification of cause of death.Conclusion:The report is intended to raise our understanding and make forensic pathologists aware of the surface of the posterior atrioventricular junction.

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Severe Tricuspid Regurgitation and Atrioventicular Block Caused by Blunt Thoracic Trauma in an Elderly Woman

Cited by 15 publications

References 6 publications

Reaming of femoral fractures with different reaming irrigator aspirator systems shows distinct effects on cardiac function after experimental polytrauma

Reaming of femoral fractures with different reaming irrigator aspirator systems shows distinct effects on cardiac function after experimental polytrauma

Early myocardial damage (EMD) and valvular insufficiency result in impaired cardiac function after multiple trauma in pigs

Sudden death due to the atrioventricular node contusion

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