Eduardo Benchimol Saad
A 32 year old male patient suffered a car accident in November 1993, when he had a toraco-abdominal closed trauma and was submited to a laparotomy for hepatic bleeding and had a hemothorax drained. At that time his chest X-ray showed an increased heart silhouete; neither ECG nor Ecocardiogram were done. He recovered uneventfully.
In the next few months, he progressively developed fatigue and dispnea during exercice, characterizing left ventricular failure. Later on he was found to be in New York Heart Association Class III - IV heart failure and in March 1994 his ECG showed an inactive zone in the inferior left ventricular wall, while the chest X-ray showed enlarged heart chambers. At that time, an Ecocardiographic study revealed a dilated left ventricle and akinetic inferior, lateral and posterior walls, with moderate mitral regurgitation produced by papilary muscle dysfunction, and severe left ventricular dysfunction.
Hemodynamic study made in December 1995 revealed increased chamber volumes and sizes, infero-posterior akinesia, difuse severe hipokinesia and moderate mitral regurgitation. In the cineangiogram, the left coronary arteries appeared normal, but the right coronary artery was found to have na extesive dissection until its distal portion, without restricting its blood flow.
The patient was sent to surgery, where he had his mitral valve replaced and an arterial bypass graft was made to the right coronary artery.