title: Left main coronary artery dissection in pediatric sport-related chest trauma.
abstract: BACKGROUND
  Traumatic coronary artery dissection (CAD) after blunt chest trauma (BCT) is extremely rare, particularly in children. Among coronary dissections, left main coronary artery (LMCA) dissection is the least common, with only two pediatric cases reported previously. Manifestations of coronary dissections can range from ST segment changes to sudden death. However, these manifestations are not specific and can be present with other cardiac injuries. To our knowledge we present the first pediatric case of traumatic LMCA dissection after sport-related BCT that was treated successfully with coronary stenting.
  
  
  METHODS
  A 14-year-old child sustained BCT during a baseball game. Early in the clinical course, he had episodes of ventricular dysrhythmias, diffuse ST changes, rising troponin I, and hemodynamic instability. Emergent cardiac catheterization revealed an LMCA dissection with extension into the proximal left anterior descending artery (LADA). A bare metal stent was placed from the LMCA to the LADA, which improved blood flow through the area of dissection. He has had almost full recovery of myocardial function and has been managed as an outpatient with oral heart failure and antiplatelet medications. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Our case highlights that CAD, although rare, can occur after pediatric BCT. Pediatric emergency responders must have a heightened awareness that evidence of ongoing myocardial ischemia, such as evolving and focal myocardial infarction on electrocardiogram, persistent elevation or rising troponin I, and worsening cardiogenic shock, can represent a coronary event and warrant further evaluation. Cardiac catheterization can be both a diagnostic and therapeutic modality in such cases. Early recognition and management is vital for myocardial recovery.
authors.affiliation: Department of Surgery, Division of Pediatric Surgery, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Jose L
authors.initials: JL
authors.lastname: Diaz-Miron
authors.affiliation: Department of Surgery, Division of Pediatric Surgery, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Dillon
authors.affiliation: Department of Pediatrics, Division of Critical Care, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Arun
authors.initials: A
authors.lastname: Saini
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, Washington University School of Medicine, St Louis, Missouri.
authors.forename: David T
authors.initials: DT
authors.lastname: Balzer
authors.affiliation: Department of Medicine, Division of Interventional Cardiology, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Jasvindar
authors.initials: J
authors.lastname: Singh
authors.affiliation: Department of Pediatrics, Division of Critical Care, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Nikoleta S
authors.initials: NS
authors.lastname: Kolovos
authors.affiliation: Department of Pediatrics, Division of Critical Care, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Jennifer G
authors.initials: JG
authors.lastname: Duncan
authors.affiliation: Department of Surgery, Division of Pediatric Surgery, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Martin S
authors.initials: MS
authors.lastname: Keller
mesh_terms: D000293:Adolescent; D000784:Aortic Dissection / Q000209:etiology*; D001484:Baseball / Q000293:injuries*; D003323:Coronary Aneurysm / Q000209:etiology*; D006801:Humans; D008297:Male; D013898:Thoracic Injuries / Q000150:complications*; D014949:Wounds, Nonpenetrating / Q000150:complications*
keywords: blunt chest trauma; dissection; left main coronary artery; pediatric