Clinical Communications: AdultsLeft Ventricular–Right Atrial Communication with Third-degree Atrioventricular Block after Thoracic Trauma
Introduction
Intracardiac shunts are rare but very serious lesions after non-penetrating chest trauma. The diagnosis is difficult, and the pathology often goes unrecognized in the context of multiple trauma. We report the case of a young man who suffered a left ventricular–right atrial communication with third-degree atrioventricular block after thoracic trauma.
Section snippets
Case Report
A 21-year-old man was involved in a motor vehicle crash with frontal impact and a decelerating mechanism. The initial evaluation found a blood pressure of 90/60 mm Hg, a pulse rate of 76 beats/min, and a Glasgow Coma Scale score of 8. Before arrival at the hospital, resuscitation with orotracheal intubation, mechanical ventilation, and colloid perfusion was initiated, and the patient was subsequently transported to the trauma center. He had no history of previous medical problem or medications.
Discussion
Intracardiac shunts are rare lesions after non-penetrating chest trauma. There have been cases of interauricular communication, ventricular communication, or cardiac tamponade, but few of acquired left ventricular to right atrial communication and complete heart block (1, 2, 3, 4).
Treatment of this patient’s cardiac injury required surgical therapy utilizing extracorporeal circulation followed by anticoagulant therapy that could have aggravated the brain and pelvic lesions. Due to a delayed
Conclusion
After severe thoracic trauma; daily clinical examination, serum troponin measurements, repeat electrocardiography, and transthoracic echocardiography are tools that can assist the clinician with the diagnosis of cardiac injuries. Transesophageal echocardiography should be performed in every trauma patient with electrocardiographic abnormalities.
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Cited by (5)
Clinical and electrocardiographic features of complete heart block after blunt cardiac injury: A systematic review of the literature
2017, Heart RhythmCitation Excerpt :About 95 articles were initially analyzed, as well as their relevant references. Clinical data were available in 50 of 59 reported cases with CHB-BCI (84.7%) and in 27 of 28 those published over the past 20 years (96.4%).7–62 Detailed information on the clinical features of these 50 cases is provided, in chronological order (starting from the more recent cases), in Supplemental Table 1.
Simultaneous "traumatic Gerbode" and aortic rupture due to blunt chest trauma
2016, Annals of Cardiac AnaesthesiaAcquired left ventricle-to-right atrium shunt: clinical implications and diagnostic dilemmas
2015, Wiener Klinische WochenschriftA systematic review of acquired left ventricle to right atrium shunts (Gerbode Defects)
2015, Hellenic Journal of CardiologyLeft ventricular to right atrial shunt (Gerbode defect): Congenital versus acquired
2014, Postepy w Kardiologii Interwencyjnej
Streaming videos: Two brief real-time ultrasound clips that accompany this article are available in streaming video at www.journals.elsevierhealth.com/periodicals/jem. Click on Video Clips 1 and 2.