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Trauma to cardiac valves
Matthew J Wall1, Ernesto R Soltero
1Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA. mwall@bcm.tmc.edu
Insights
Cardiorrhaphy can involve complex cardiac injuries like valvular damage, often diagnosed late. Early suspicion and advanced imaging like transesophageal echocardiography are crucial for timely repair or replacement.
Area of Science:
- Cardiovascular Surgery
- Trauma Care
- Diagnostic Imaging
Background:
- Cardiorrhaphy is a common trauma procedure, but complicated cardiac injuries present unique challenges.
- Cardiac valvular injuries, including septal defects and coronary artery damage, are often diagnosed subacutely.
- A new murmur is a key indicator for suspecting valvular injury in trauma patients.
Purpose of the Study:
- To highlight the diagnostic and management strategies for complicated cardiac injuries following trauma.
- To emphasize the role of advanced imaging and a high index of suspicion in patient care.
Main Methods:
- Review of diagnostic modalities including physical examination (murmur detection) and advanced imaging.
- Discussion of the utility of Transesophageal Echocardiography (TEE) for diagnosis and intraoperative guidance.
- Consideration of Cardiac Catheterization for selected patients with complex coronary or valvular injuries.
Main Results:
- Cardiac valvular injuries are frequently diagnosed subacutely.
- Transesophageal echocardiography is increasingly valuable for diagnosing these injuries and aiding intraoperative management.
- Surgical techniques include primary repair or prosthetic replacement of damaged cardiac structures.
Conclusions:
- A high index of suspicion is essential for diagnosing rare but serious cardiac injuries in trauma patients.
- Timely diagnosis and appropriate intervention, utilizing advanced imaging and surgical techniques, improve outcomes.
- Management strategies must be tailored to the specific injury, ranging from repair to prosthetic replacement.
Abstract:
Cardiorrhaphy is a relatively common procedure performed in a trauma center. However, there is a subgroup of patients with more complicated cardiac injuries such as coronary artery injuries, septal defects, and valvular injuries. Cardiac valvular injuries are often diagnosed subacutely when a new murmur is heard. Transesophageal echocardiography has been increasingly performed to diagnosis these injuries and may be helpful intraoperatively. Cardiac catheterization may be indicated in selected patients. Techniques to address these injuries may involve repair or prosthetic replacement. A high index of suspicion is needed to diagnose these relatively rare injuries.