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Chest trauma may result in bruising of the heart, disruption of the pericardial sheath surrounding the heart, perforation of the septum, valve damage, and other injuries. Although less common, damage to the coronary arteries may also be observed as a consequence of blunt, i.e. nonpenetrating, chest trauma. Recently, a 34-year-old carpenter fell off a 12-foot ladder and landed flat on his back on a stone floor. He suffered chest pain and shortness of breath, but these symptoms resolved rapidly, and no physician was consulted. The next morning, the man awoke with severe chest pain, and an electrocardiogram revealed a pattern indicating a myocardial infarction. Angiography (an X-ray of the blood vessels around the heart) was performed, and a dissecting aneurysm was ruled out; although most arteries were without irregularities, the left anterior descending coronary artery was found to be blocked. Emergency percutaneous transluminal coronary angioplasty (PTCA), in which a balloon is inserted and expanded to open a blocked artery, was performed. After four weeks the patient was discharged free of symptoms and after four months improvement in left ventricular function was observed. The authors observe that most cases of myocardial infarction are treated conservatively, and recommend that angioplasty be done as rapidly as possible. Although the use of PTCA for myocardial infarction is controversial, the authors recommend that it should be considered as a option in cases when the artery blockage appears to be associated with trauma. (Consumer Summary produced by Reliance Medical Information, Inc.)

The study explores the long-term results of surgical rebuilding. or valvuloplasty, of the tricuspid valve of the heart separating the right atrium and ventricle. The pre- and post-operative data used in this study were collected by ultrasound and cardiac catheterization studies of the hearts of these patients. The authors divided the patients into 3 groups: clear clinical improvement; no clinical improvement with valvular difficulties; and deteriorated clinical status. Although difficulties do exist, the authors find the long-term results of valvular surgery of the tricuspid valve encouraging. The authors also conclude that the use of Doppler ultrasound techniques, a means of measuring blood flow from a simple external examination, is equivalent to the results obtained by invasive pressure measurement, and that this method is therefore suitable for this class of patients.