HEART TRAUMA FOLLOWING BLUNT CHEST INJURIES

Violent chest injuries due to road traffic accidents account for the majority of deaths in persons under 40 years of age and among these cardiac trauma due to road traffic accidents is one of leading cause of death. I present a case report in which a 45 years old taxi driver sustained road accident. On auscultation there was no cardiac murmur. ECG showed normal sinus rhythm with non specific ST-T changes. Echocardiography was unremarkable. He was sent home. After four days he turned up with shortness of breath. On auscultation there was grade 4/6 early diastolic murmur down the left sternal boarder, a loud S3 and fine basal crackles. X-ray chest showed widening of mediastinum with upper lobe shunting suggestive of left ventricular failure. Patient underwent cardiac catheterization and coronary angiography. It revealed left anterior descending artery occlusion distal to first septal perforator and frank aortic regurgitation. Trans-oesophageal echocardiography showed moderately severe aortic regurgitation. Patient underwent cardiac surgery. Aortic cusp was excised and prosthesis inserted. Left anterior descending artery was grafted with left internal mammary artery. Patient recovered uneventful and was sent home on oral anticoagulant.