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Cottini M, Pergolini A, Ranocchi F, Musumeci F. The Role of Heart Team Approach in Penetrating Cardiac Trauma: Case Report and Review of the Literature. Braz J Cardiovasc Surg 2018; 33:99-103. [PMID: 29617508 PMCID: PMC5873782 DOI: 10.21470/1678-9741-2017-0150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 09/06/2017] [Indexed: 11/04/2022] Open
Abstract
Penetrating cardiac trauma has been increasing in clinical experience and is joined to important morbidity and mortality. A case of a 38-year-old female with history of postpartum depression was reported, admitted to our department for cardiac tamponade due to penetrating self-inflicted multiple stab wound of the chest complicated by rupture of anterior left ventricular wall and traumatic ventricular septal defect. Following the unstable hemodynamic instability, a combined therapeutic strategy was chosen: surgery and transcatheter implantation to correct free wall ventricle damage and traumatic ventricular septal defect, respectively.
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Affiliation(s)
- Marzia Cottini
- Department of Heart and Vessels, Cardiac Surgery Unit and Heart
Transplantation Center, "S. Camillo-Forlanini" Hospital, Rome, Italy
| | - Amedeo Pergolini
- Department of Heart and Vessels, Cardiac Surgery Unit and Heart
Transplantation Center, "S. Camillo-Forlanini" Hospital, Rome, Italy
| | - Federico Ranocchi
- Department of Heart and Vessels, Cardiac Surgery Unit and Heart
Transplantation Center, "S. Camillo-Forlanini" Hospital, Rome, Italy
| | - Francesco Musumeci
- Department of Heart and Vessels, Cardiac Surgery Unit and Heart
Transplantation Center, "S. Camillo-Forlanini" Hospital, Rome, Italy
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2
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Harling L, Ashrafian H, Casula RP, Athanasiou T. Late surgical repair of a traumatic ventricular septal defect. J Cardiothorac Surg 2014; 9:145. [PMID: 25239775 PMCID: PMC4198620 DOI: 10.1186/s13019-014-0145-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 08/11/2014] [Indexed: 12/03/2022] Open
Abstract
Ventricular Septal Defect (VSD) complicates approximately 1-5% of patients presenting with penetrating chest trauma, however not all VSDs are evident at the time of initial presentation to the emergency department. Acute closure of traumatic VSDs is indicated in patients with a large defect and haemodynamic compromise, however closure may be delayed in smaller defects in order to minimise operative time, reduce operative mortality and allow for recovery from the initial trauma. We describe the case of a previously healthy 23 year-old Caucasian man who presented in extremis following stab wounds to the precordium. After emergency cardiopulmonary bypass and closure of lacerations to both the left and right ventricles, postoperative trans-thoracic echocardiography (TTE) noted a restrictive intramuscular VSD with a high velocity left to right shunt, initially managed conservatively. Elective surgical closure was performed 10 months after the initial injury through a right ventriculotomy using 4–0 Proline sutures reinforced with Teflon pledgets. Despite excellent clinical recovery, 3-month follow-up TTE noted a residual VSD in the mid apical septum. However, given the presence of minimal left to right shunt and the small size of the defect, the patient was managed conservatively with annual review and repeat transthoracic echo. This case highlights the potential pitfalls in both the diagnosis and management of traumatic VSDs particularly where the patient presents in extremis with other life-threatening injuries. Furthermore, it exemplifies the importance of a multidisciplinary approach when planning any elective intervention. Regardless of the management strategy, repeated re-assessment and re-evaluation is vital following penetrating cardiac trauma, and vigilant long-term follow-up is of paramount importance in these cases.
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Affiliation(s)
| | | | | | - Thanos Athanasiou
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK.
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Dedic A, Nieman K, Bogers AJJC, Witsenburg M. Transcatheter closure of a traumatic ventricular septum defect resulting from a stab wound. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2014; 4:96-9. [PMID: 24585940 DOI: 10.1177/2048872613507119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 25-year-old man with a ventricular septal defect resulting from a stab wound to his chest was admitted to our hospital. Because of extensive comorbidity and favourable location, transcatheter closure with an Amplatzer device was preferred over surgical repair. Ventricular septal defects are an uncommon complication of cardiac trauma, but when they do occur from this cause, they often have more dramatic consequences. Transcatheter closure is an attractive, less-invasive alternative in patients with increased surgical risk, multiple previous surgical interventions, or poorly accessible defects.
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Affiliation(s)
- A Dedic
- Erasmus Medical Center, Rotterdam, The Netherlands
| | - K Nieman
- Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - M Witsenburg
- Erasmus Medical Center, Rotterdam, The Netherlands
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Itoh T, Koeda C, Mifune T, Komuro K, Fusazaki T, Endo H, Shimoda Y, Yoshioka K, Morino Y, Nakamura M. Spontaneous healing of saccular type aneurysm with ventricular septal lacerations after blunt chest trauma. J Cardiol Cases 2013; 7:e149-e152. [PMID: 30533148 DOI: 10.1016/j.jccase.2013.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 01/08/2013] [Accepted: 01/23/2013] [Indexed: 10/27/2022] Open
Abstract
We present a case of spontaneous healing of saccular type aneurysm with ventricular septal lacerations after blunt chest trauma. A 50-year-old Japanese man was transferred to our hospital diagnosed with ventricular septal lacerations after blunt chest trauma. Electrocardiogram (ECG) at admission showed ST elevations in I, II, III, aVL, aVF, V2-through to V6 were observed. Laboratory data showed elevated creatine kinase. Echocardiogram revealed normal ventricular contraction and a saccular type ventricular septal laceration with an influx blood flow without septal shunt flow. After admission, serial echocardiogram and cardiac computed enhancement tomography showed disappearance of a saccular type ventricular septal laceration. Gadolinium-enhanced magnetic resonance imaging (MRI) was performed at day 30. MRI showed an enhanced scar of saccular type aneurysm with ventricular septal laceration; this image suggested some residual damage of ventricular septal laceration. At discharge, ECG was resolved with normal ST-T level and no Q wave, but persistent complete right bundle branch block and left axis deviation. After one year, repeat MRI showed a scar of saccular type aneurysm with ventricular septal laceration. <Learning objective: To recognize spontaneous healing of saccular type aneurysm with ventricular septal lacerations after blunt chest trauma. This is a case of saccular type aneurysm with ventricular septal laceration after non-penetrating blunt chest trauma successfully healed with conservative therapy. There are many case reports of blunt chest trauma, however, there are few reports of treatment with conservative therapy.>.
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Affiliation(s)
- Tomonori Itoh
- Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical university
| | - Chikahiko Koeda
- Division of Cardioangiology, Nephrology, and Endocrinology, Department of Internal Medicine, Iwate Medical University
| | - Toshihide Mifune
- Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical university
| | - Kentaro Komuro
- Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical university
| | - Tetsuya Fusazaki
- Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical university
| | - Hiroshi Endo
- Division of Cardiology, Iwate prefecture Ohofunato Hospital
| | - Yudai Shimoda
- Division of Cardiology, Iwate prefecture Ohofunato Hospital
| | - Kunihiro Yoshioka
- Division of Radiology, Memorial Heart Center, Iwate Medical University
| | - Yoshihiro Morino
- Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical university
| | - Motoyuki Nakamura
- Division of Cardioangiology, Nephrology, and Endocrinology, Department of Internal Medicine, Iwate Medical University
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5
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De'Ath HDI, Vulliamy PED, Davies C, Uppal R. A large ventricular septal defect complicating resuscitation after blunt trauma. J Emerg Trauma Shock 2012; 5:350-2. [PMID: 23248508 PMCID: PMC3519052 DOI: 10.4103/0974-2700.102409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2010] [Accepted: 06/07/2011] [Indexed: 11/04/2022] Open
Abstract
A young adult pedestrian was admitted to hospital after being hit by a car. On arrival to the Accident and Emergency Department, the patient was tachycardic, hypotensive, hypoxic, and acidotic with a Glasgow Coma Scale of 3. Despite initial interventions, the patient remained persistently hypotensive. An echocardiogram demonstrated a traumatic ventricular septal defect (VSD) with right ventricular strain and increased pulmonary artery pressure. Following a period of stabilization, open cardiothoracic surgery was performed and revealed an aneurysmal septum with a single large defect. This was repaired with a bovine patch, resulting in normalization of right ventricular function. This case provides a vivid depiction of a large VSD in a patient following blunt chest trauma with hemodynamic compromise. In all thoracic trauma patients, and particularly those poorly responsive to resuscitation, VSDs should be considered. Relevant investigations and management strategies are discussed.
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Affiliation(s)
- Henry D I De'Ath
- Trauma Clinical and Academic Unit, The Royal London Hospital, Whitechapel, London, E1 1BB,, United Kingdom
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Stein E, Daigle S, Weiss SJ, Desai ND, Augoustides JGT. CASE 3-2011: successful management of a complicated traumatic ventricular septal defect. J Cardiothorac Vasc Anesth 2011; 25:547-52. [PMID: 21398145 DOI: 10.1053/j.jvca.2011.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Indexed: 11/11/2022]
Affiliation(s)
- Erica Stein
- Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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Traumatic ventricular septal defect following a stab wound to the chest. Gen Thorac Cardiovasc Surg 2009; 57:148-50. [PMID: 19280311 DOI: 10.1007/s11748-008-0347-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Accepted: 09/21/2008] [Indexed: 10/21/2022]
Abstract
A 51-year-old man who had been suffering from depression stabbed himself in the chest with an ice pick. At presentation, an ice pick lodged in the left fifth intercostal space was moving synchronously with his heartbeat. Echocardiography revealed that the tip was penetrating the anterior wall of the right ventricle. Because the patient was tamponading, an emergency operation was carried out. The ice pick was removed following the establishment of a cardiopulmonary bypass and pericardiotomy. The perforation of the right ventricle was closed with a pledget-reinforced mattress stitch. On postoperative day 12, a holosystolic murmur was detected on auscultation. Transthoracic echocardiography revealed a ventricular septal defect 5 mm in diameter located near the apex. The pulmonary-tosystemic flow ratio was 1.1 by echocardiographic measurement. No sign of heart failure was present. Although it was agreed to manage the ventricular septal defect conservatively, careful echocardiographic follow-up is mandatory.
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Massad MG, Khoury F, Evans A, Sirois C, Chaer R, Thomas Y, Snow NJ, Briller J, Geha AS. Late presentation of retained intracardiac ice pick with papillary muscle injury. Ann Thorac Surg 2002; 73:1623-6. [PMID: 12022562 DOI: 10.1016/s0003-4975(01)03367-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
An unusual case of a penetrating intracardiac injury is described in a 16-year-old boy who presented with a retained 14-cm segment of an ice pick that went unnoticed by the patient for 4 days. The ice pick had lacerated the anterior papillary muscle of the left ventricle causing avulsion of its tip and prolapse of the anterior leaflet of the mitral valve resulting in severe mitral regurgitation. The urgency for surgical correction of the traumatic mitral valve injury at the time of extraction of the intracardiac foreign body through a single-stage approach versus a two-stage approach is discussed.
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Affiliation(s)
- Malek G Massad
- Division of Cardiothoracic Surgery, The University of Illinois at Chicago, College of Medicine, 60612, USA.
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Tĕsínský L, Pirk J, al-Hiti H, Málek I. An isolated ventricular septal defect as a consequence of penetrating injury to the heart. Eur J Cardiothorac Surg 1999; 15:221-3. [PMID: 10219561 DOI: 10.1016/s1010-7940(98)00297-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The authors describe, in a case report, an isolated defect of the ventricular septum developing due to a stab injury to the heart not requiring an emergency surgical intervention. Two months after the injury, the authors performed primary surgical correction of the defect.
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Affiliation(s)
- L Tĕsínský
- Department of Cardiovascular and Transplantation Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
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Ilia R, Goldfarb B, Wanderman KL, Gueron M. Spontaneous closure of a traumatic ventricular septal defect after blunt trauma documented by serial echocardiography. J Am Soc Echocardiogr 1992; 5:203-5. [PMID: 1571179 DOI: 10.1016/s0894-7317(14)80555-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A ventricular septal defect (caused by blunt chest trauma) that closed spontaneously over a period of 5 years was documented by serial echo-Doppler examinations. The shunt was relatively small and the patient was without symptoms from the time the lesion was discovered until its closure. In the absence of cardiac decompensation or pulmonary hypertension, a conservative approach, including serial echo-Doppler examinations, can be justified.
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Affiliation(s)
- R Ilia
- Department of Cardiology, Soroka Medical Center, Beer-Sheva, Israel
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