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Teresa Ojode1, Joshua W Sappenfield1
1Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United States.
Insights
Thoracic trauma can injure coronary bypass grafts, a rare but life-threatening condition. Prompt diagnosis and cardiac catheterization with stenting are crucial for managing these critical injuries.
Area of Science:
- Cardiology
- Trauma Surgery
- Vascular Surgery
Background:
- Thoracic trauma can affect thoracic organs and great vessels, including coronary arteries.
- Coronary bypass graft injuries are rare but potentially fatal consequences of thoracic trauma.
- Diagnosis and management are complicated by the graft's nature, often unclear during emergencies.
Observation:
- A case of occult, life-threatening coronary bypass graft injury from thoracic trauma is presented.
- The patient required cardiac catheterization and an exclusionary stent for hemostasis.
- Previous reports include native coronary injury and one medically managed bypass graft injury.
Findings:
- Coronary bypass graft injuries from thoracic trauma are rare but life-threatening.
- Cardiac catheterization and stenting can effectively manage these injuries with high suspicion.
- Early cardiac studies in high-impact thoracic trauma patients with bypass grafts aid diagnosis.
Implications:
- A high index of suspicion is vital for diagnosing coronary bypass graft injuries post-trauma.
- Cardiac catheterization offers a viable management strategy for these critical injuries.
- Enhanced diagnostic protocols for trauma patients with bypass grafts can improve outcomes.
Abstract:
Thoracic trauma poses a risk of injury to the thoracic organs and great vessels, including the coronaries. We present an interesting case of occult, life-threatening coronary bypass graft injury resulting from thoracic trauma. In this case, the diagnosis and management were contingent on understanding the nature of the bypass graft, which was not apparent at the time of presentation in extremis. Ultimate hemostasis required cardiac catheterization and placement of an exclusionary stent. Though there are several case reports describing native coronary injury resulting from thoracic injury, we found a single case of thoracic trauma-associated coronary bypass graft injury, which was managed medically. The case we present here demonstrates that though coronary bypass graft injuries are life-threatening and rare, they can be managed with techniques utilizing cardiac catheterization if accompanied by a high index of suspicion. This case further demonstrates that additional cardiac studies for patients who present with high-impact thoracic injuries and a history of coronary bypass grafts may facilitate expeditious diagnosis and effective management.
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