PMC4900402_01
The electrocardiogram revealed incomplete right bundle branch block with left posterior hemiblock
ACA-19-182-g001.jpg
PMC4900402_01_ACA-19-182-g001.jpg
F1
The electrocardiogram revealed incomplete right bundle branch block with left posterior hemiblock [Figure 1].
Computed tomography showing the rupture of the aortic isthmus (arrow) with the presence of pseudoaneurysm and mediastinal hematoma
ACA-19-182-g002.jpg
PMC4900402_01_ACA-19-182-g002.jpg
F2
The patient underwent computed tomography (CT) scan which displayed bilateral pleural effusions with compression atelectasis, fractures of the 3rd, 4th, and 5th right costal ribs, contusion in the right lung, and rupture of the aortic isthmus with the presence of pseudoaneurysm and mediastinal hematoma [Figure 2].
The aortography performed, confirmed the computed tomography findings
ACA-19-182-g003.jpg
PMC4900402_01_ACA-19-182-g003.jpg
F3
No other site of blood extravasation was found [Figure 3].
A stentgraft was inserted to the descending aorta, at the isthmus level
ACA-19-182-g004.jpg
PMC4900402_01_ACA-19-182-g004.jpg
F4
A stentgraft was inserted to the descending aorta, at the isthmus level [Figure 4].
The transthoracic echo cardio performed show an abnormal blood flow between the left ventricle and the right atrium (arrow)
ACA-19-182-g005.jpg
PMC4900402_01_ACA-19-182-g005.jpg
F5
Due to this borderline value and the systolic murmur aforementioned, a transthoracic cardiac ultrasound was performed, which disclosed an abnormal blood flow between the left ventricle and the right atrium without any remarkable findings regarding the right chambers [Figure 5].
Diagram showing the alanine aminotransferase course
ACA-19-182-g006.jpg
PMC4900402_01_ACA-19-182-g006.jpg
F6
Aspartate aminotransferase 455 IU, alanine aminotransferase (ALT) 543 IU, normal <40 IU), creatine phosphokinase (CPK) 1388 (normal <190), CPK-MB 71 (normal <18), troponin (hsTpn) 245 ng/ml (normal <14, grey zone 14-56) [Figures 6-8].
Diagram showing the lactate dehydrogenase course
ACA-19-182-g007.jpg
PMC4900402_01_ACA-19-182-g007.jpg
F7
Aspartate aminotransferase 455 IU, alanine aminotransferase (ALT) 543 IU, normal <40 IU), creatine phosphokinase (CPK) 1388 (normal <190), CPK-MB 71 (normal <18), troponin (hsTpn) 245 ng/ml (normal <14, grey zone 14-56) [Figures 6-8].
Diagram showing the aspartate aminotransferase course
ACA-19-182-g008.jpg
PMC4900402_01_ACA-19-182-g008.jpg
F8
Aspartate aminotransferase 455 IU, alanine aminotransferase (ALT) 543 IU, normal <40 IU), creatine phosphokinase (CPK) 1388 (normal <190), CPK-MB 71 (normal <18), troponin (hsTpn) 245 ng/ml (normal <14, grey zone 14-56) [Figures 6-8].
In this surgical field the defect was detected (arrow)
ACA-19-182-g009.jpg
PMC4900402_01_ACA-19-182-g009.jpg
F9
A right atriotomy was performed after total cardiopulmonary bypass (CPB) establishement and the defect was immediately detected [Figure 9].
A pericardial patch (arrow) was sutured in order to repair this shunt
ACA-19-182-g010.jpg
PMC4900402_01_ACA-19-182-g010.jpg
F10
A pericardial patch was sutured in order to repair this shunt with horizontal mattress stiches [Figure 10].