Case Study Late Revascularization of the Anterior Descending Coronary Artery in a Young Patient with Previous Myocardial Infarction Caused by Blunt Chest Trauma An Option for the Left Internal Thoracic Artery? Paulo Roberto Barbosa Evora, Maurício Shigueo Oshiro, Daniel Gonçalves de Souza, Antonio Carlos Menardi 1 168 European Journal of Trauma 2005 · No. 2 © Urban & Vogel European Journal of Trauma Abstract A myocardial infarction secondary to a left anterior de- scending coronary artery (LAD) injury in a 29-year-old male, following a motorcycle accident, is reported. The option for late myocardial revascularization with in situ LAD/left internal thoracic artery (LITA) anastomosis is emphasized as the particularity of this case report. Key Words Blunt chest trauma · Coronary trauma · Coronary artery bypass graft · Left internal thoracic artery Eur J Trauma 2005;31:168–9 DOI 10.1007/s00068-005-1377-5 Introduction Blunt chest trauma is one of the nonatherosclerotic mechanisms leading to acute myocardial infarction (MI) in young adults. Coronary artery injuries after nonpen- etrating thoracic trauma are little recognized, and al- though MI is well reported in the specialized medical literature, it is an unusual clinical condition. Therefore, we herein report an MI secondary to a left anterior de- scending coronary artery (LAD) injury after a motor- cycle accident. The option for late myocardial revascu- larization with in situ LAD/left internal thoracic artery (LITA) anastomosis is emphasized as the particularity of this case report. Case Study A 29-year-old male patient without any personal history of tabagism, arterial hypertension, diabetes or chest an- gina, nor any family history of coronary heart disease, came to a community hospital after a motorcycle colli- sion. He complained of diffuse thoracic pain, and his physical examination revealed pain only on palpation of the superficial right shoulder and anterior superior chest. X-ray examination showed fractures of the first right rib only. The enzymes creatine phosphokinase (CPK), cre- atine kinase muscle-brain type (CK-MB), and lactate de- hydrogenase (LDH) were evaluated, leading to the fol- lowing values: 863.0 U/l, 68.8 U/l, and 1,080.0 U/l, respectively. Subsequent exams were not accomplished. Since there was diagnostic doubt in terms of MI or myo- cardial contusion, thrombolytics were not used. As the patient’s ECG was suggestive of anterior MI or contusion, the patient was transferred to a tertiary care hospital. An initial Doppler echocardiogram was compatible with myocardial contusion, demonstrating hypokinesia of the interventricular septum and apical segment of the left ventricle’s inferior wall. A new echo- cardiogram performed 5 days after the accident demon- strated a septal-apical and anterior-apical hypokinesia probably caused by myocardial contusion. By this time, the patient’s thoracic pain was still being treated with analgesics only; the enzymes had normalized with clini- cal improvement, and he was discharged 8 days after the accident. 1 CECORP (Ribeirão Preto Specialized Heart and Lung Center), Ribeirão Preto, SP, Brazil. Received: October 27, 2003; revision accepted: January 13, 2005.