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Pseudoaneurysm of Left Ventricle as a Late Manifestation of Thoracic Trauma by Hoof Kick of a Horse

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Pseudoaneurysm of Left Ventricle as a Late Manifestation of Thoracic Trauma by Hoof Kick of a Horse

K Ghema, Pr S Salimi, Pr B Slaoui.
Department of Pediatrics, A Harouchi Pediatric Hospital, Casablanca, Morocco.
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Ghema K, Salimi P S, Slaoui P B. Pseudoaneurysm of Left Ventricle as a Late Manifestation of Thoracic Trauma by Hoof Kick of a Horse. Pediatr Oncall J. 2020;17. doi: 10.7199/ped.oncall.2020.24

ARTICLE HISTORY
Received 6 December 2019
Accepted 11 April 2020

ADDRESS FOR CORRESPONDANCE
Dr K Ghema, 13 Pierre Parent Street, Casablanca, Morocco.
Email: karima.ghema91@gmail.com

Keywords
chest trauma, pseudoaneurysm, tricuspid insufficiency
 
A 14 years old boy presented with left-sided chest pain, breathlessness, and ecchymosis at the left side of his chest 4 hours after a chest trauma by a hoof kick of a horse. On examination, there was a cardiovascular failure with hypotension (blood pressure 80/50 mm of Hg) and tachycardia (heart rate 140/min), dyspnea, and ecchymosis at the left side of his chest. On the day of admission, the CT chest was normal. Electrocardiogram (ECG) showed a right branch block on V1 and V2 leads. Transthoracic echocardiography (TTE) demonstrated an interventricular communication of 5 mm in size, a large tricuspid valve leak with probable dislocation of the tricuspid valve. Cardiac MRI on the second day of admission showed Magnetic resonance imaging (MRI) performed 2 days after the injury demonstrated traumatic tricuspid insufficiency, dilation of the right-side cavities, and prolapse of the septal leaflet with a left ventricular ejection fraction of >60%. Five days after the injury, open-heart surgery was performed. Interatrial communication was closed and reimplantation of the anterior pillar of the tricuspid valve with tricuspid valvo plasty was done. However, the interventricular communication was inoperable. He had an uneventful post-operative period. Six months later, left and right cardiac catheterization was performed which showed 3 mm muscular restrictive media septal interventricular communication with normal intra-cardiac pressures and saturations.bTTE performed after 2 years showed dilatation of the left ventricular with conservation of its function with post-traumatic communication of the left ventricular with the infundibulum without signs of endocarditis. Three years after injury, he had dyspnea with asthenia. Thoracic MRI showed acommunication of the left ventricular with the infundibulum (false aneurysm of the left ventricle). Cardiac catheterization was performed with the closure of the interventricular communication by a 6 mm prosthesis (LIFETECH heart R VSD occlude). There was disappearance of the dyspnea, asthenia, and murmur in a few days.
Thoracic blunt trauma to the heart occurs much more frequently than one would suspect.1 Valvar lesions occur in less than 1% of the cases and are predominantly of the aortic and mitral valves. Ventricular and atrial septal defects occur even more rarely in thoracic blunt trauma. Lesions of the coronary arteries (laceration, thrombosis, dissection of the ostium) have been found in less than 2% of cases in an autopsy series.2 In our patient, there was the tricuspid insufficiency with interventricular communication. These lesions cannot be congenital because he had no dyspnea or breathlessness previously. The evolution of cardiac complications in thoracic trauma can be chronic. In our case, the pseudoaneurysm had been discovered 2 years after injury. The pseudoaneurysm of the left ventricular is often asymptomatic. The interval between the chest trauma and the symptomatology can go from five days to twenty years.3,4 Thus, in post-trauma, cardiac lesions should be monitored for a long period to detect complications at earlier stages.
 
Compliance with Ethical Standards
 
Funding None
 
Conflict of Interest None
 
References:
  1. Getz BS. Blunt Cardiac Trauma Resulting in Right Atrial Rupture. JAMA. 1986;255: 761.  [CrossRef]  [PubMed]
  2. Chirillo F, Totis O, Cavarzerani A, Bruni A, Farnia A, Sarpellon M, et al. Usefulness of transthoracic and transesophageal echocardiography in recognition and management of cardiovascular injuries after blunt chest trauma. Heart. 1996; 75: 301-6.  [CrossRef]  [PubMed]  [PMC free article]
  3. Dada M, Noyez L, Verheugt FWA, Brouwer RMHJ. Delayed diagnosis of a posttraumatic ventricular aneurysm. Interactive Cardiovasc Thorac Surgery. 2003;2:84-6.  [CrossRef]
  4. El-Behery S, Barrea C, Sluysmans T. Traumatic left ventricular true aneurysm: echocardiographic, MRI, and intraoperative images. Heart 2006;92:726.  [CrossRef]  [PubMed]  [PMC free article]

DOI No.: https://doi.org/10.7199/ped.oncall.2020.24

Cite this article as:
Ghema K, Salimi P S, Slaoui P B. Pseudoaneurysm of Left Ventricle as a Late Manifestation of Thoracic Trauma by Hoof Kick of a Horse. Pediatr Oncall J. 2020;17. doi: 10.7199/ped.oncall.2020.24
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