Management of Traumatic Coronary Artery Injuries: Advantages of Off-Pump Coronary Artery Bypass

Myocardial infarction following repair of a ruptured heart

Penetrating chest trauma can lead to the cardiac rupture and coronary artery damage, which causes a high mortality rate (1). Most of the patients with penetrating cardiac trauma die at the scene of the accident (1). Coronary artery (CA) injuries are rare but highly lethal (2). Also, CA injury may occur during repair of a ruptured heart as in our reported case.

Delayed revascularization following complete transection of left anterior descending artery after a stab wound

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Complete coronary artery transection after a stab wound is survivable.

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At even slight suspicion, surgical exploration of pericardial sac and heart is always strongly justified.

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Off-pump coronary artery by-pass is a safe alternative for transected artery treatment.

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Examination and treatment of cardiac injuries in facility with “heart team” and cardiac surgical expertise is always strongly recommended.

Introduction

Penetrating heart injury as a consequence of a stab wound is usually considered fatal. Nevertheless, there are rare lucky cases with mild symptoms which deserve clinical suspicion and proper management.

Presentation of case

We report a penetrating cardiac trauma with left anterior descending coronary artery transection after a stab wound. Successful revascularization without cardiopulmonary bypass support was performed.

Discussion

Coronary artery injuries after penetrating cardiac trauma are mostly fatal. The standard approach has traditionally been coronary artery ligation with serious morbidity. We report a case of complete coronary artery transection with delayed revascularization validating the safety of off-pump approach. We add a short literature review of the management of traumatic coronary artery injury.

Conclusion

This adds to the world literature on coronary artery trauma with successful off-pump revascularization. Coronary artery transection stab-wound victims can have only mild symptoms. Slightest intimation of heart injury should provoke proper clinical examination and management.