흉부 둔상 환자에서 심초음파도로 진단한 심손상

Abstract

Blunt trauma of the chest and abdomen frequently result in cardiac injury. We experienced a 47 year-old male patient of myocardial contusion with aortic insufficiency after blunt chest trauma. On the secondd day after admission, the patient developed sudden hypoxemia and wide pulse pressure. A pulmonary arterial catheter was inserted and initial cardiac output and pulmonary capillary wedge pressure was 3.56L/min/m* and 32mmHg, rspectively. There was akinesia of the anterior septum, anterior wall, inferior wall and inferior septum with aortic regurgitation(I/IV), and the ejection fraction was 25% on echocardiogram. Myocardial contusion with valvular injury was suspected. Dobutamine infusion was started and after five days the pulmonary capillary wedge pressure was decreased to 14 mmHg. The ejection fraction was increased to 69% in spite of decreasing dobutamine but aortic regurgitation(II/VI) remained. Therefore echocardiogram and pulmonary artery catheterization will be helpful to diagnose suspected cardiac contusion and for better outcome.