Myocardial Contusions – ABC CARDIOL

IJCS

Case Report

Surgical Resolution of Penetrating Cardiac Injury: A Case Report of a Serrated Knife Blade Blow

Jaísse Valente Cruz et al. Adnaldo da Silveira Maia Giovana dos Santos Couto Giselle Macedo de Souza

Abstract

Severe cardiac injuries, such as blunt or penetrating injuries caused by bladed weapons, require early diagnosis, usually by electrocardiography, tomography, and Focused Assessment With Sonography in Trauma (FAST). This study describes a case of penetrating cardiac trauma successfully treated by surgical intervention. During surgery, the medical team identified a serrated knife blade in the anterior chest wall, associated with a rib fracture and pericardial injury, without compromising the diaphragm. The patient had a positive outcome after the intervention. Effective management of these injuries depends on understanding the trauma mechanism and the patient’s characteristics, allowing for a rapid response and potentially life-saving therapies.

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ABC

Letter to the Editor

High-Sensitivity Troponin in Non-Cardiac Surgery

Can Özkan

Dear Editor,

I read with great interest the article entitled “Addition of High-Sensitivity Troponin to Perioperative Risk Assessment Improves the Predictive Ability of Death in Non-Cardiac Surgery Patients” by Gomes et al. the prevalence of myocardial injury is higher in high-risk patients, including those with cardiovascular, surgical, and clinical risks. They also reported that the occurrence of non-cardiac surgical myocardial injury in the population not considered high-risk cannot be overlooked and leads to high mortality in this population. In long-term follow-up, the prognosis of high-risk patients without myocardial injury is worse compared to high-risk patients without myocardial injury. Some comments may be useful.

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ABC

Original Article

Myocardial Injury Progression after Radiofrequency Ablation in School-Age Children

Sissy Lara de Melo et al. Alberto Pereira Ferraz Stephanie Ondracek Lemouche Marcela Santana Devido … Gabriela Liberato de Sousa Carlos E. Rochitte Cristiano Faria Pisani Denise Tessariol Hachul Mauricio Scanavacca

Abstract

Background

The past decades have seen the rapid development of the invasive treatment of arrhythmias by catheter ablation procedures. Despite its safety and efficacy being well-established in adults, to date there has been little data in pediatric scenarios. One of the main concerns is the possible expansion of the ablation procedure scar in this population and its consequences over the years.

Objectives

This study aimed to analyze the risk of myocardial injury progression after radiofrequency catheter ablation in pediatric patients.

Methods

This is a retrospective study of 20 pediatric patients with previous ablation for treatment of supraventricular arrhythmia that underwent cardiac magnetic resonance and coronary angiography for evaluation of myocardial fibrosis and the integrity of the coronary arteries during follow-up.

Results

The median age at ablation procedure was 15.1 years (Q1 12.9, Q3 16.6) and 21 years (Q1 20, Q3 23) when the cardiac magnetic resonance was performed. Fourteen of them were women. Nodal reentry tachycardia and Wolf-Parkinson-White Syndrome were the main diagnosis (19 patients), with one patient with atrial tachycardia. Three patients had ventricular myocardial fibrosis, but with a volume < 0.6 cm ³ . None of them developed ventricular dysfunction and no patient had coronary lesions on angiography.

Conclusion

Radiofrequency catheter ablation did not show to increase the risk of myocardial injury progression or coronary artery lesions.

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ABCIC

Case Report

Atrial Fibrillation and Tricuspid Regurgitation as Late Presentations of Contusio Cordis

Marcos Merula de Almeida et al. Noemí Rocío Andrade Alban Galo Juvenal Vinueza Aguay

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ABC

Review Article

Myocardial Injury after Non-cardiac Surgery – State of the Art

Antonio José Lagoeiro Jorge et al. Evandro Tinoco Mesquita Wolney de Andrade Martins

Abstract

Approximately 300 million non-cardiac surgeries are performed annually worldwide and adverse cardiovascular events are the main cause of morbidity and mortality in the peri- and postoperative period. Myocardial injury after non-cardiac surgery (MINS) is a new clinical entity associated with adverse cardiovascular outcomes. MINS is defined as myocardial injury that can result in necrosis due to ischemia, marked by increase in biomarker levels. It has prognostic relevance and occurs within up to 30 days after non-cardiac surgery. The diagnostic criteria for MINS are an elevated postoperative measure of troponin judged as secondary to myocardial ischemia, i.e., with no evidence of a non-ischemic etiology, during or within 30 days after non-cardiac surgery, and without the requirement of an ischemic symptom or electrocardiographic finding of ischemia. Recently, patients at higher risk for MINS have been recognized using clinical variables and biomarkers and established protocols for greater surveillance in relation to electrocardiographic monitoring and cardiac troponin dosage. Elderly patients with previous atherosclerotic disease need to measure troponin daily in the postoperative period. The aim of the present work is to describe this new public health problem, its clinical impact and contemporary therapeutic approach.

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IJCS

Original Article

Predictive Value of Myocardial injury in Patients with COVID-19 Admitted to a Quaternary Hospital in the City of Rio de Janeiro

Antônio Sérgio Cordeiro da Rocha et al. Andre Volschan Luiz Antonio Almeida Campos Roberta Pereira dos Santos Coelho … Dominique Cardoso de Almeida Thielmann Carlos Augusto Lobbe Cotta Ferreira Alexandre Siciliano Colafranceschi

Abstract

Background

In Brazil the factors involved in the risk of death in patients with COVID-19 have not been well established.

Objective

To analyze whether elevations of high-sensitivity troponin I (hTnI) levels influence the mortality of patients with COVID-19.

Methods

Clinical and laboratory characteristics of hospitalized patients with COVID-19 were collected upon hospital admission. Univariate and binary logistic regression analyzes were performed to assess the factors that influence mortality. P-value<0.05 was considered significant.

Results

This study analyzed192 patients who received hospital admission between March 16 and June 2, 2020 and who were discharged or died by July 2, 2020. The mean age was 70±15 years, 80 (41.7%) of whom were women. In comparison to those who were discharged, the 54 (28.1%) who died were older (79±12 vs 66±15years; P=0.004), and with a higher Charlson´s index (5±2 vs 3±2; P=0.027). More patients, aged≥60years (P 1 (P=0.004), lung injury>50% in chest computed tomography (P=0.011), with previous coronary artery disease (P=0.037), hypertension (P=0.033), stroke (P=0.008), heart failure (P=0.002), lymphocytopenia (P=0.024), high D-dimer (P=0.024), high INR (P=0.003), hTnI (P<0.0001), high creatinine (P<0.0001), invasive mechanical ventilation (P<0.0001), renal replacement therapy (P<0.0001), vasoactive amine (P<0.0001), and transfer to the ICU (P=0.001), died when compared to those who were discharged. In logistic regression analysis, elevated hTnI levels (OR=9.504; 95% CI=1.281–70.528; P=0.028) upon admission, and the need for mechanical ventilation during hospitalization (OR=46.691; 95% CI=2.360–923.706; P=0.012) increased the chance of in-hospital mortality.

Conclusion

This study suggests that in COVID-19 disease, myocardial injury upon hospital admission is a harbinger of poor prognosis.

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ABC

Case Report

Transcatheter Closure of a Traumatic VSD with an ASD Occluder

Rui Alexandre Pontes dos Santos et al. Henrique Guedes Leonor Marques Carolina Lourenço … João Carlos Silva Paula Pinto

Introduction

Traumatic ventricular septal defects (VSD) are exceptionally rare. They can be a consequence of either blunt or penetrating trauma. It is believed that most patients die before reaching the hospital, which makes this condition even more challenging.

Percutaneous closure of traumatic VSD has been presented as an alternative to open conventional surgery. Transcatheter intervention may have some benefits. The objective of this case report is to present a situation where the defect was closed using an Amplatzer septal occluder.

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