Cardiovascular Revascularization Medicine xxx (2014) xxx–xxx
Contents lists available at ScienceDirect
Cardiovascular Revascularization Medicine
Left main dissection complicating blunt chest trauma: Case report and review of literature Federico Colombo a, Andrea Zuffi b, Alessandro Lupi c,⁎ a b c
Division of Cardiology, S. Biagio Hospital, Domodossola, Italy Catheterization Laboratory, Villa Torri Hospital, Bologna, Italy Cardiology II, “Maggiore della Carità” University Hospital, Novara, Italy
a r t i c l e
i n f o
Article history: Received 20 February 2014 received in revised form 2 April 2014 accepted 9 April 2014 Available online xxxx Keywords: Unprotected left main angioplasty Chest trauma Coronary dissection Coronary rupture Acute coronary syndrome
a b s t r a c t Coronary artery injury after blunt chest trauma is rare, but can be life-threatening, resulting in severe myocardial ischaemia and acute myocardial infarction. We report a case of a 56-year-old male who presented a few days after a blunt chest trauma with crescendo unstable angina. Coronary angiography demonstrated left main coronary artery dissection that was fixed with stent implantation. After a blunt chest trauma symptoms and electrocardiographic findings of a coronary dissection can be nonspecific and confounded by the chest tenderness. In such cases careful evaluation to rule out traumatic coronary injuries is warranted and early intervention should not be delayed in the presence of clear evidence of myocardial ischemia. © 2014 Elsevier Inc. All rights reserved.
1. Introduction Blunt chest trauma is frequently associated with a list of complications like pneumothorax, rib fractures, lung perforation, liver and spleen ruptures, cardiac contusion with pericardial effusion or tamponade and vascular injuries [1]. Coronary injures can be found in a very small percentage of patients [2–5], but these cases are often recognized and treated late because traumatic chest pain sometimes masks angina pain and distracts physicians from recognizing potentially devastating complications like left main or proximal LAD dissection/rupture. We present a case of severe blunt chest trauma complicated by left main coronary dissection with a sneaky presentation leading to delayed diagnosis and treatment.
2. Case report A 56-year-old man was admitted to our Hospital for worsening anginal attacks (typical anginal pain for minimal efforts, diffuse ST depression at 12-lead ECG) without biomarker alterations, occurring 7 days after a blunt chest trauma (overturning of a farm tractor). The patient was obese, had quit smoking for 5 years and was in medical treatment for arterial hypertension with an ACE-inhibitor. ⁎ Corresponding author at: Cardiologia Seconda, Emodinamica Ospedaliera, AOU Maggiore della Carità, Novara, Italy. Tel.: +39 0321 3733236, +39 349 5643838 (mobile). E-mail address: [email protected] (A. Lupi).
After the chest trauma the patient was evaluated a first time in our institutional ED. Chest X ray showed X and XI right rib fractures, right pneumothorax and a small pericardial effusion, but 12-lead ECG was unremarkable and cardiac troponin I (cTnI) curve was negative for myocardial infarction. Moreover echocardiography showed no left or right ventricular regional wall abnormalities. The pneumothorax was drained and patient was discharged with broad spectrum antibiotics, NSAID and codeine prescription. When the pain due to chest compression improved and mobilization began the patient recognized another symptom, a chest oppression associated with even minimal efforts. Thus he referred again to the ED where sampling for cTnI continued to be negative and a new ECG showed sinus tachycardia with diffuse ST segment depression and negative T waves from V1 to V6 (Fig. 1). At admission the patient was slightly hypertensive (150/90 mmHg), heart rate was 80 bpm, neither jugular engorgement nor calf oedema was present, lungs were clear and a 4th heart sound was audible without other cardiac murmurs. A large thoracic graze with bruise and chest tenderness was evident. The patient was admitted to CCU and scheduled for urgent cardiac catheterization. Coronary angiography undisclosed left main (LM) dissection with aneurismal dilatation (Fig. 2, panel A and B) and IVUS imaging confirmed the presence of a large and irregular intimal flap arising from an eccentric atheroma of the middle-distal left main (Fig. 3). Cardiac surgeon on ward refused the case due to the recent chest wall trauma with serious concerns about the possibility to use the internal thoracic arteries for bypass conduits. Thus the patient received an oral load of aspirin 300 mg and clopidogrel 600 mg and direct coronary stenting of the LM with a bare
http://dx.doi.org/10.1016/j.carrev.2014.04.004 1553-8389/© 2014 Elsevier Inc. All rights reserved.
Please cite this article as: Colombo F, et al, Left main dissection complicating blunt chest trauma: Case report and review of literature, Cardiovasc Revasc Med (2014), http://dx.doi.org/10.1016/j.carrev.2014.04.004
2
F. Colombo et al. / Cardiovascular Revascularization Medicine xxx (2014) xxx–xxx
Fig. 1. The ECG showing ST segment depression and T wave inversion from V1 to V6.
metal stent (Multilink Zeta 5.0 × 18 mm) optimized with high pressure oversized balloon dilation was performed, with optimal final angiographic result (Fig. 2 panel C, D and E). The patient was discharged without complications the following day, with a prescription for 6-month double antiplatelet therapy (DAPT). Two year clinical and angiographic follow up was unremarkable (Fig. 2 panel F). 3. Discussion Cardiac injuries after blunt chest trauma are not uncommon, occurring in about 5%–15% of chest traumas [6] and in 15% of autopsy surveys [7], even if most of them are not clinically recognized [1]. The most frequent complication is cardiac contusion with myocardial necrosis, arrhythmias, pericardial effusion or tamponade, generally due to blunt chest trauma against the car steering column and less frequently for deceleration trauma [1].
Traumatic coronary artery dissection was first described by Kohli et al. in 1988 [5]. Post-traumatic coronary artery damage with dissection and/or perforation is considerably less frequent, with less than 10% of cases with post-traumatic myocardial necrosis attributable to ischemic events [8]. These figures are probably underrated, as in some cases patients are totally asymptomatic and no tests for detecting inducible ischemia are routinely performed. Coronary artery dissection is most common in the LAD (76%), RCA (12%), and the circumflex (6%), while bilateral coronary artery dissection and left main dissection were seldom reported [9]. Five kinds of coronary lesions after blunt chest trauma are described: dissection due to intimal tear, thrombosis due to artery compression, de novo stenosis due to external compression or subintimal edema, coronary rupture and coronary fistula [2–4,10]. The mechanisms of post traumatic coronary lesions are basically two. The first is the direct traumatism that mainly affects right coronary artery, due to its anterior position. The
Fig. 2. Panel A and B show the gross left main (LM) dissection with an aneurismal sac on the LM roof. In Panel C and D LM direct stenting with bare metal stent and immediate results are demonstrated. Panel E shows LM postdilation result with a well expanded endo-prosthesis but with a residual aneurismal sac. Panel F shows the 6 month angiographic follow up, with absence of restenosis and near complete disappearance of the LM aneurysm.
Please cite this article as: Colombo F, et al, Left main dissection complicating blunt chest trauma: Case report and review of literature, Cardiovasc Revasc Med (2014), http://dx.doi.org/10.1016/j.carrev.2014.04.004
F. Colombo et al. / Cardiovascular Revascularization Medicine xxx (2014) xxx–xxx
3
dissection in 15.8% [13]. Very limited information about long term outcomes is available in literature, with anecdotal reports about favorable course in patients treated medically [20]. It is conceivable that the outcomes of patients treated with PCI should be similar to patients treated for iatrogenic damage to major coronary arteries, depending on the pre-existing atherosclerotic burden and the use of bare metal or drug eluting stent. In our patient we resorted to a bare metal stent, even if the lesion involved the left main, due to the large dimension of the vessel and the unavailability of suitable drug eluting stent measures. Moreover the presence of a large residual aneurismal sac in the left main shaft would have been a source of concern for late malapposition in case of DES deployment. However the angiographic follow up at 1 and 2 years was unremarkable, with near complete obliteration of the aneurism. 4. Conclusions Coronary artery injury after blunt chest trauma is rare, but can be life-threatening, presenting as unstable angina or myocardial infarction. Symptoms of such a condition are often misleading and diagnosis requires a high suspicion rate. Treatment of traumatic coronary injuries relies on interventional techniques and coronary stenting, with generally excellent short and long term outcomes. Fig. 3. The figure shows IVUS picture of the gross left main dissection with a large and irregular intimal flap (white arrows) arising from an eccentric atheroma of the middledistal left main (yellow asterisks).
second is the simultaneous twist and strain forces at the aortic root compromising proximal coronary tracts, generally the distal part of the left main and the proximal part of the left anterior descending coronary artery [3,4,11]. As important contributory causes, atherosclerosis or collagen diseases greatly increase the rupture risk, stiffening and weakening the vessel walls [8,12]. The latter point could help to understand why in the case described the dissection affected an uncommon location like the middle portion of the left main, as IVUS imaging demonstrated that this region was affected by an eccentric atheroma conferring inhomogeneous stiffness to the vessel wall and predisposing it to traumatic rupture. The treatment of traumatic coronary injuries is mainly interventional, as thrombolysis after severe trauma could be hazardous [13]. If the patients have typical symptoms PCI can be generally performed early [14] and often an IVUS guide can provide useful information to the interventional procedure [15]. Other imaging methods, like ECGgated computed tomography (CT) and magnetic resonance imaging (MRI) can add important clues to diagnosis and treatment of such lesions, as last generation CT scanners can detect even intra-coronary flaps and MR apparels can not only distinguish between myocardial infarction and contusion by late MR enhancement but can also display coronary wall hematomas [16,17]. However, when presentation is sneaky and symptoms are vague or confused with those arising from the injured chest wall, delayed treatment is still possible with good results [18], as in the case described. In stable patients with complex coronary injuries cardiac surgery can be considered [14,19], even if chest trauma often casts doubts about the involvement of the internal thoracic arteries and contraindicates CABG. Finally in some patients without symptoms and signs of ongoing ischemia a conservative approach has been safely employed [20]. The prognosis of traumatic coronary injuries depends on the coronary segments involved, the presence and the extension of myocardial injury and the therapeutic approach to the coronary dissection. Left main involvement is often but not invariably fatal, as demonstrated by our and other cases [21]. Data about the mortality of such patients are seldom reported: in the review of Christiansen et al. 6 of 77 patients died early after trauma for AMI and, of the 71 survivors, 90% underwent coronary angiography with evidence of coronary artery occlusion in 56.6% and
References [1] Karmy-Jones R, Jurkovich GJ. Blunt chest trauma. Curr Probl Surg 2004;41:223–380. [2] Candell J, Valle V, Paya J, Cortadellas J, Esplugas E, Rius J. Post-traumatic coronary occlusion and early left ventricular aneurysm. Am Heart J 1979;97:509–12. [3] Kahn JK, Buda AJ. Long-term follow-up of coronary artery occlusion secondary to blunt chest trauma. Am Heart J 1987;113:207–10. [4] Voyce SJ, Ball SP, Gore JM, Shine WJ, Weiner BH. Angiographically documented thrombotic coronary artery occlusion secondary to mild nonpenetrating thoracic trauma. Cathet Cardiovasc Diagn 1991;24:179–81. [5] Kohli S, Saperia GM, Waksmonski CA, Pezzella S, Singh JB. Coronary artery dissection secondary to blunt chest trauma. Cathet Cardiovasc Diagn 1988;15:179–83. [6] Atalar E, Açil T, Aytemir K, Ozer N, Ovünç K, Aksöyek S, et al. Acute anterior myocardial infarction following a mild nonpenetrating chest trauma—a case report. Angiology 2001;52:279–82. [7] Kissane RW. Traumatic heart disease; nonpenetrating injuries. Circulation 1952;6:421–5. [8] Brasseur E, Ghuysen A, Mommens V, Janssen N, Legrand V, D'Orio V. Coronary dissection and non-penetrating chest trauma. Ann Cardiol Angeiol 2006;55:233–9. [9] Shao Y, Xia W, Zhang C, Wang X. Bilateral coronary dissection after blunt thoracic trauma: a case report. Can J Cardiol 2012;28(515):e1–2. [10] Heymann TD, Culling W. It's not cricket! Myocardial infarction following nonpenetrating blunt chest trauma. Br J Clin Pract 1994;48:338–9. [11] Leong D, Brown M. Blunt traumatic dissection of the proximal left anterior descending artery. Emerg Med J 2006;23:e67. [12] Choudhury L, Marsh JD. Myocardial infarction in young patients. Am J Med 1999;107:254–61. [13] Christensen MD, Nielsen PE, Sleight P. Prior blunt chest trauma may be a cause of single vessel coronary disease; hypothesis and review. Int J Cardiol 2006;108:1–5. [14] Al-Aqeedi RF, Ali WM, Al-Ani F, Abdulrahman YS, Alnabti A. A blunt chest trauma causing left anterior descending artery dissection and acute myocardial infarction treated by deferred angioplasty. Heart Views 2011;12:71–3. [15] Moreno R, Pérez del Todo J, Nieto M, Alba F, Alfonso F, Garcia-Rubira JC, et al. Primary stenting in acute myocardial infarction secondary to right coronary artery dissection following blunt chest trauma. Usefulness of intracoronary ultrasound. Int J Cardiol 2005;103:209–11. [16] Malbranque G, Serfaty JM, Himbert D, Steg PG, Laissy JP. Myocardial infarction after blunt chest trauma: usefulness of cardiac ECG-gated CT and MRI for positive and aetiologic diagnosis. Emerg Radiol 2011;18:271–4. [17] Ricci F, Radico F, Zimarino M, Marano R, De Caterina R. Minimally aggressive treatment of spontaneous coronary artery dissections. J Cardiovasc Med 2013;14:166–7. [18] da Silva AC, de Paula JE, Mozer GW, Toledo LF, Soares RL, Albertal M. Simultaneous dissection and intramural hematoma of left anterior descending and circumflex coronary arteries after blunt chest trauma. Int J Cardiol 2012;155:e34–6. [19] James MM, Verhofste M, Franklin C, Beilman G, Goldman C. Dissection of the left main coronary artery after blunt thoracic trauma: case report and literature review. World J Emerg Surg 2010;5:21. [20] Masuda T, Akiyama H, Kurosawa T, Ohwada T. Long-term follow-up of coronary artery dissection due to blunt chest trauma with spontaneous healing in a young woman. Intensive Care Med 1996;22:450–2. [21] Lobay KW, MacGougan CK. Traumatic coronary artery dissection: a case report and literature review. J Emerg Med 2012;43:e239–43.
Please cite this article as: Colombo F, et al, Left main dissection complicating blunt chest trauma: Case report and review of literature, Cardiovasc Revasc Med (2014), http://dx.doi.org/10.1016/j.carrev.2014.04.004
Contents lists available at ScienceDirect
Cardiovascular Revascularization Medicine
Left main dissection complicating blunt chest trauma: Case report and review of literature Federico Colombo a, Andrea Zuffi b, Alessandro Lupi c,⁎ a b c
Division of Cardiology, S. Biagio Hospital, Domodossola, Italy Catheterization Laboratory, Villa Torri Hospital, Bologna, Italy Cardiology II, “Maggiore della Carità” University Hospital, Novara, Italy
a r t i c l e
i n f o
Article history: Received 20 February 2014 received in revised form 2 April 2014 accepted 9 April 2014 Available online xxxx Keywords: Unprotected left main angioplasty Chest trauma Coronary dissection Coronary rupture Acute coronary syndrome
a b s t r a c t Coronary artery injury after blunt chest trauma is rare, but can be life-threatening, resulting in severe myocardial ischaemia and acute myocardial infarction. We report a case of a 56-year-old male who presented a few days after a blunt chest trauma with crescendo unstable angina. Coronary angiography demonstrated left main coronary artery dissection that was fixed with stent implantation. After a blunt chest trauma symptoms and electrocardiographic findings of a coronary dissection can be nonspecific and confounded by the chest tenderness. In such cases careful evaluation to rule out traumatic coronary injuries is warranted and early intervention should not be delayed in the presence of clear evidence of myocardial ischemia. © 2014 Elsevier Inc. All rights reserved.
1. Introduction Blunt chest trauma is frequently associated with a list of complications like pneumothorax, rib fractures, lung perforation, liver and spleen ruptures, cardiac contusion with pericardial effusion or tamponade and vascular injuries [1]. Coronary injures can be found in a very small percentage of patients [2–5], but these cases are often recognized and treated late because traumatic chest pain sometimes masks angina pain and distracts physicians from recognizing potentially devastating complications like left main or proximal LAD dissection/rupture. We present a case of severe blunt chest trauma complicated by left main coronary dissection with a sneaky presentation leading to delayed diagnosis and treatment.
2. Case report A 56-year-old man was admitted to our Hospital for worsening anginal attacks (typical anginal pain for minimal efforts, diffuse ST depression at 12-lead ECG) without biomarker alterations, occurring 7 days after a blunt chest trauma (overturning of a farm tractor). The patient was obese, had quit smoking for 5 years and was in medical treatment for arterial hypertension with an ACE-inhibitor. ⁎ Corresponding author at: Cardiologia Seconda, Emodinamica Ospedaliera, AOU Maggiore della Carità, Novara, Italy. Tel.: +39 0321 3733236, +39 349 5643838 (mobile). E-mail address: [email protected] (A. Lupi).
After the chest trauma the patient was evaluated a first time in our institutional ED. Chest X ray showed X and XI right rib fractures, right pneumothorax and a small pericardial effusion, but 12-lead ECG was unremarkable and cardiac troponin I (cTnI) curve was negative for myocardial infarction. Moreover echocardiography showed no left or right ventricular regional wall abnormalities. The pneumothorax was drained and patient was discharged with broad spectrum antibiotics, NSAID and codeine prescription. When the pain due to chest compression improved and mobilization began the patient recognized another symptom, a chest oppression associated with even minimal efforts. Thus he referred again to the ED where sampling for cTnI continued to be negative and a new ECG showed sinus tachycardia with diffuse ST segment depression and negative T waves from V1 to V6 (Fig. 1). At admission the patient was slightly hypertensive (150/90 mmHg), heart rate was 80 bpm, neither jugular engorgement nor calf oedema was present, lungs were clear and a 4th heart sound was audible without other cardiac murmurs. A large thoracic graze with bruise and chest tenderness was evident. The patient was admitted to CCU and scheduled for urgent cardiac catheterization. Coronary angiography undisclosed left main (LM) dissection with aneurismal dilatation (Fig. 2, panel A and B) and IVUS imaging confirmed the presence of a large and irregular intimal flap arising from an eccentric atheroma of the middle-distal left main (Fig. 3). Cardiac surgeon on ward refused the case due to the recent chest wall trauma with serious concerns about the possibility to use the internal thoracic arteries for bypass conduits. Thus the patient received an oral load of aspirin 300 mg and clopidogrel 600 mg and direct coronary stenting of the LM with a bare
http://dx.doi.org/10.1016/j.carrev.2014.04.004 1553-8389/© 2014 Elsevier Inc. All rights reserved.
Please cite this article as: Colombo F, et al, Left main dissection complicating blunt chest trauma: Case report and review of literature, Cardiovasc Revasc Med (2014), http://dx.doi.org/10.1016/j.carrev.2014.04.004
2
F. Colombo et al. / Cardiovascular Revascularization Medicine xxx (2014) xxx–xxx
Fig. 1. The ECG showing ST segment depression and T wave inversion from V1 to V6.
metal stent (Multilink Zeta 5.0 × 18 mm) optimized with high pressure oversized balloon dilation was performed, with optimal final angiographic result (Fig. 2 panel C, D and E). The patient was discharged without complications the following day, with a prescription for 6-month double antiplatelet therapy (DAPT). Two year clinical and angiographic follow up was unremarkable (Fig. 2 panel F). 3. Discussion Cardiac injuries after blunt chest trauma are not uncommon, occurring in about 5%–15% of chest traumas [6] and in 15% of autopsy surveys [7], even if most of them are not clinically recognized [1]. The most frequent complication is cardiac contusion with myocardial necrosis, arrhythmias, pericardial effusion or tamponade, generally due to blunt chest trauma against the car steering column and less frequently for deceleration trauma [1].
Traumatic coronary artery dissection was first described by Kohli et al. in 1988 [5]. Post-traumatic coronary artery damage with dissection and/or perforation is considerably less frequent, with less than 10% of cases with post-traumatic myocardial necrosis attributable to ischemic events [8]. These figures are probably underrated, as in some cases patients are totally asymptomatic and no tests for detecting inducible ischemia are routinely performed. Coronary artery dissection is most common in the LAD (76%), RCA (12%), and the circumflex (6%), while bilateral coronary artery dissection and left main dissection were seldom reported [9]. Five kinds of coronary lesions after blunt chest trauma are described: dissection due to intimal tear, thrombosis due to artery compression, de novo stenosis due to external compression or subintimal edema, coronary rupture and coronary fistula [2–4,10]. The mechanisms of post traumatic coronary lesions are basically two. The first is the direct traumatism that mainly affects right coronary artery, due to its anterior position. The
Fig. 2. Panel A and B show the gross left main (LM) dissection with an aneurismal sac on the LM roof. In Panel C and D LM direct stenting with bare metal stent and immediate results are demonstrated. Panel E shows LM postdilation result with a well expanded endo-prosthesis but with a residual aneurismal sac. Panel F shows the 6 month angiographic follow up, with absence of restenosis and near complete disappearance of the LM aneurysm.
Please cite this article as: Colombo F, et al, Left main dissection complicating blunt chest trauma: Case report and review of literature, Cardiovasc Revasc Med (2014), http://dx.doi.org/10.1016/j.carrev.2014.04.004
F. Colombo et al. / Cardiovascular Revascularization Medicine xxx (2014) xxx–xxx
3
dissection in 15.8% [13]. Very limited information about long term outcomes is available in literature, with anecdotal reports about favorable course in patients treated medically [20]. It is conceivable that the outcomes of patients treated with PCI should be similar to patients treated for iatrogenic damage to major coronary arteries, depending on the pre-existing atherosclerotic burden and the use of bare metal or drug eluting stent. In our patient we resorted to a bare metal stent, even if the lesion involved the left main, due to the large dimension of the vessel and the unavailability of suitable drug eluting stent measures. Moreover the presence of a large residual aneurismal sac in the left main shaft would have been a source of concern for late malapposition in case of DES deployment. However the angiographic follow up at 1 and 2 years was unremarkable, with near complete obliteration of the aneurism. 4. Conclusions Coronary artery injury after blunt chest trauma is rare, but can be life-threatening, presenting as unstable angina or myocardial infarction. Symptoms of such a condition are often misleading and diagnosis requires a high suspicion rate. Treatment of traumatic coronary injuries relies on interventional techniques and coronary stenting, with generally excellent short and long term outcomes. Fig. 3. The figure shows IVUS picture of the gross left main dissection with a large and irregular intimal flap (white arrows) arising from an eccentric atheroma of the middledistal left main (yellow asterisks).
second is the simultaneous twist and strain forces at the aortic root compromising proximal coronary tracts, generally the distal part of the left main and the proximal part of the left anterior descending coronary artery [3,4,11]. As important contributory causes, atherosclerosis or collagen diseases greatly increase the rupture risk, stiffening and weakening the vessel walls [8,12]. The latter point could help to understand why in the case described the dissection affected an uncommon location like the middle portion of the left main, as IVUS imaging demonstrated that this region was affected by an eccentric atheroma conferring inhomogeneous stiffness to the vessel wall and predisposing it to traumatic rupture. The treatment of traumatic coronary injuries is mainly interventional, as thrombolysis after severe trauma could be hazardous [13]. If the patients have typical symptoms PCI can be generally performed early [14] and often an IVUS guide can provide useful information to the interventional procedure [15]. Other imaging methods, like ECGgated computed tomography (CT) and magnetic resonance imaging (MRI) can add important clues to diagnosis and treatment of such lesions, as last generation CT scanners can detect even intra-coronary flaps and MR apparels can not only distinguish between myocardial infarction and contusion by late MR enhancement but can also display coronary wall hematomas [16,17]. However, when presentation is sneaky and symptoms are vague or confused with those arising from the injured chest wall, delayed treatment is still possible with good results [18], as in the case described. In stable patients with complex coronary injuries cardiac surgery can be considered [14,19], even if chest trauma often casts doubts about the involvement of the internal thoracic arteries and contraindicates CABG. Finally in some patients without symptoms and signs of ongoing ischemia a conservative approach has been safely employed [20]. The prognosis of traumatic coronary injuries depends on the coronary segments involved, the presence and the extension of myocardial injury and the therapeutic approach to the coronary dissection. Left main involvement is often but not invariably fatal, as demonstrated by our and other cases [21]. Data about the mortality of such patients are seldom reported: in the review of Christiansen et al. 6 of 77 patients died early after trauma for AMI and, of the 71 survivors, 90% underwent coronary angiography with evidence of coronary artery occlusion in 56.6% and
References [1] Karmy-Jones R, Jurkovich GJ. Blunt chest trauma. Curr Probl Surg 2004;41:223–380. [2] Candell J, Valle V, Paya J, Cortadellas J, Esplugas E, Rius J. Post-traumatic coronary occlusion and early left ventricular aneurysm. Am Heart J 1979;97:509–12. [3] Kahn JK, Buda AJ. Long-term follow-up of coronary artery occlusion secondary to blunt chest trauma. Am Heart J 1987;113:207–10. [4] Voyce SJ, Ball SP, Gore JM, Shine WJ, Weiner BH. Angiographically documented thrombotic coronary artery occlusion secondary to mild nonpenetrating thoracic trauma. Cathet Cardiovasc Diagn 1991;24:179–81. [5] Kohli S, Saperia GM, Waksmonski CA, Pezzella S, Singh JB. Coronary artery dissection secondary to blunt chest trauma. Cathet Cardiovasc Diagn 1988;15:179–83. [6] Atalar E, Açil T, Aytemir K, Ozer N, Ovünç K, Aksöyek S, et al. Acute anterior myocardial infarction following a mild nonpenetrating chest trauma—a case report. Angiology 2001;52:279–82. [7] Kissane RW. Traumatic heart disease; nonpenetrating injuries. Circulation 1952;6:421–5. [8] Brasseur E, Ghuysen A, Mommens V, Janssen N, Legrand V, D'Orio V. Coronary dissection and non-penetrating chest trauma. Ann Cardiol Angeiol 2006;55:233–9. [9] Shao Y, Xia W, Zhang C, Wang X. Bilateral coronary dissection after blunt thoracic trauma: a case report. Can J Cardiol 2012;28(515):e1–2. [10] Heymann TD, Culling W. It's not cricket! Myocardial infarction following nonpenetrating blunt chest trauma. Br J Clin Pract 1994;48:338–9. [11] Leong D, Brown M. Blunt traumatic dissection of the proximal left anterior descending artery. Emerg Med J 2006;23:e67. [12] Choudhury L, Marsh JD. Myocardial infarction in young patients. Am J Med 1999;107:254–61. [13] Christensen MD, Nielsen PE, Sleight P. Prior blunt chest trauma may be a cause of single vessel coronary disease; hypothesis and review. Int J Cardiol 2006;108:1–5. [14] Al-Aqeedi RF, Ali WM, Al-Ani F, Abdulrahman YS, Alnabti A. A blunt chest trauma causing left anterior descending artery dissection and acute myocardial infarction treated by deferred angioplasty. Heart Views 2011;12:71–3. [15] Moreno R, Pérez del Todo J, Nieto M, Alba F, Alfonso F, Garcia-Rubira JC, et al. Primary stenting in acute myocardial infarction secondary to right coronary artery dissection following blunt chest trauma. Usefulness of intracoronary ultrasound. Int J Cardiol 2005;103:209–11. [16] Malbranque G, Serfaty JM, Himbert D, Steg PG, Laissy JP. Myocardial infarction after blunt chest trauma: usefulness of cardiac ECG-gated CT and MRI for positive and aetiologic diagnosis. Emerg Radiol 2011;18:271–4. [17] Ricci F, Radico F, Zimarino M, Marano R, De Caterina R. Minimally aggressive treatment of spontaneous coronary artery dissections. J Cardiovasc Med 2013;14:166–7. [18] da Silva AC, de Paula JE, Mozer GW, Toledo LF, Soares RL, Albertal M. Simultaneous dissection and intramural hematoma of left anterior descending and circumflex coronary arteries after blunt chest trauma. Int J Cardiol 2012;155:e34–6. [19] James MM, Verhofste M, Franklin C, Beilman G, Goldman C. Dissection of the left main coronary artery after blunt thoracic trauma: case report and literature review. World J Emerg Surg 2010;5:21. [20] Masuda T, Akiyama H, Kurosawa T, Ohwada T. Long-term follow-up of coronary artery dissection due to blunt chest trauma with spontaneous healing in a young woman. Intensive Care Med 1996;22:450–2. [21] Lobay KW, MacGougan CK. Traumatic coronary artery dissection: a case report and literature review. J Emerg Med 2012;43:e239–43.
Please cite this article as: Colombo F, et al, Left main dissection complicating blunt chest trauma: Case report and review of literature, Cardiovasc Revasc Med (2014), http://dx.doi.org/10.1016/j.carrev.2014.04.004
