case_images: PMC4900402_01
case_images: The electrocardiogram revealed incomplete right bundle branch block with left posterior hemiblock
case_images: ACA-19-182-g001.jpg
case_images: PMC4900402_01_ACA-19-182-g001.jpg
case_images: F1
case_images: The electrocardiogram revealed incomplete right bundle branch block with left posterior hemiblock [Figure 1].
case_images: Computed tomography showing the rupture of the aortic isthmus (arrow) with the presence of pseudoaneurysm and mediastinal hematoma
case_images: ACA-19-182-g002.jpg
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case_images: F2
case_images: 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].
case_images: The aortography performed, confirmed the computed tomography findings
case_images: ACA-19-182-g003.jpg
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case_images: F3
case_images: No other site of blood extravasation was found [Figure 3].
case_images: A stentgraft was inserted to the descending aorta, at the isthmus level
case_images: ACA-19-182-g004.jpg
case_images: PMC4900402_01_ACA-19-182-g004.jpg
case_images: F4
case_images: A stentgraft was inserted to the descending aorta, at the isthmus level [Figure 4].
case_images: The transthoracic echo cardio performed show an abnormal blood flow between the left ventricle and the right atrium (arrow)
case_images: ACA-19-182-g005.jpg
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case_images: F5
case_images: 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].
case_images: Diagram showing the alanine aminotransferase course
case_images: ACA-19-182-g006.jpg
case_images: PMC4900402_01_ACA-19-182-g006.jpg
case_images: F6
case_images: 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].
case_images: Diagram showing the lactate dehydrogenase course
case_images: ACA-19-182-g007.jpg
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case_images: F7
case_images: 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].
case_images: Diagram showing the aspartate aminotransferase course
case_images: ACA-19-182-g008.jpg
case_images: PMC4900402_01_ACA-19-182-g008.jpg
case_images: F8
case_images: 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].
case_images: In this surgical field the defect was detected (arrow)
case_images: ACA-19-182-g009.jpg
case_images: PMC4900402_01_ACA-19-182-g009.jpg
case_images: F9
case_images: A right atriotomy was performed after total cardiopulmonary bypass (CPB) establishement and the defect was immediately detected [Figure 9].
case_images: A pericardial patch (arrow) was sutured in order to repair this shunt
case_images: ACA-19-182-g010.jpg
case_images: PMC4900402_01_ACA-19-182-g010.jpg
case_images: F10
case_images: A pericardial patch was sutured in order to repair this shunt with horizontal mattress stiches [Figure 10].