Management of Contained Penetrating Cardiac Injury in a Patient with Prior Cardiac Surgery

Overview

Journal BMJ Case Rep

Specialty General Medicine

Date 2024 Mar 5

PMID 38442974

Authors

Toyokazu Endo

Matthew G Peters

C Danielle Hopkins

Mark S Slaughter

Keith R Miller

Affiliations

Soon will be listed here.

Abstract

Penetrating cardiac injuries usually require emergent surgical intervention. Our patient presented to the trauma centre with multiple stab wounds to the neck, chest, epigastric region and abdomen. She arrived haemodynamically stable, and her initial Focused Assessment with Sonography for Trauma exam was negative. Her chest X-ray did not show any evident pneumothorax or haemothorax. Due to her injury pattern, she was taken to the operating room for exploratory laparotomy and neck exploration. Postoperatively, she was taken for CT and found to have a contained cardiac rupture. The injury was contained within previous scar tissue from her prior cardiac surgery. Further evaluation revealed that the injury included a penetrating stab wound to the right ventricle and a traumatic ventricular septal defect (VSD). She subsequently underwent a redo sternotomy with the repair of the penetrating stab wound and the VSD. Cardiology, intensive care, trauma surgery and cardiothoracic surgery coordinated her care from diagnosis, management and recovery. This case highlights the challenges in the management of cardiac injuries and the benefits of a multidisciplinary approach to care for complex cardiac injuries.

References

May A, Patterson M, Rue 3rd L, Schiller H, Rotondo M, Schwab C . Combined blunt cardiac and pericardial rupture: review of the literature and report of a new diagnostic algorithm. Am Surg. 1999; 65(6):568-74. View

Chughtai T, Gilardino M, Fleiszer D, Evans D, Brown R, Mulder D . An expanding role for cardiopulmonary bypass in trauma. Can J Surg. 2002; 45(2):95-103. PMC: 3686929. View

Tran H, Charles M, Garrett R, Kempe P, Howard C, Khorgami Z . Ten-Year Trends in Traumatic Cardiac Injury and Outcomes: A Trauma Registry Analysis. Ann Thorac Surg. 2020; 110(3):844-848. DOI: 10.1016/j.athoracsur.2019.12.038. View

Seamon M, Haut E, Van Arendonk K, Barbosa R, Chiu W, Dente C . An evidence-based approach to patient selection for emergency department thoracotomy: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2015; 79(1):159-73. DOI: 10.1097/TA.0000000000000648. View

Asensio J, Ogun O, Petrone P, Perez-Alonso A, Wagner M, Bertellotti R . Penetrating cardiac injuries: predictive model for outcomes based on 2016 patients from the National Trauma Data Bank. Eur J Trauma Emerg Surg. 2017; 44(6):835-841. DOI: 10.1007/s00068-017-0806-6. View

Rendon F, Gomez Danes L, Castro M . Delayed cardiac tamponade after penetrating thoracic trauma. Asian Cardiovasc Thorac Ann. 2004; 12(2):139-42. DOI: 10.1177/021849230401200212. View

OConnor J, Ditillo M, Scalea T . Penetrating cardiac injury. J R Army Med Corps. 2010; 155(3):185-90. DOI: 10.1136/jramc-155-03-02. View

Carr J, Buterakos R, Bowling W, Janson L, Kralovich K, Copeland C . Long-term functional and echocardiographic assessment after penetrating cardiac injury: 5-year follow-up results. J Trauma. 2011; 70(3):701-4. DOI: 10.1097/TA.0b013e31820c405a. View

Lee A, Morad Hameed S, Kaminsky M, Ball C . Penetrating cardiac trauma. Surg Open Sci. 2022; 11:45-55. PMC: 9713325. DOI: 10.1016/j.sopen.2022.11.001. View

10.

Kim E, Song S, Kim S, Lee N, Lee S . Role of extracorporeal life support for traumatic hemopericardium: A single level I trauma center review. Injury. 2023; 55(1):111193. DOI: 10.1016/j.injury.2023.111193. View

11.

Ball C, Williams B, Wyrzykowski A, Nicholas J, Rozycki G, Feliciano D . A caveat to the performance of pericardial ultrasound in patients with penetrating cardiac wounds. J Trauma. 2009; 67(5):1123-4. DOI: 10.1097/TA.0b013e3181b16f30. View

12.

Gonzalez-Hadad A, Ordonez C, Parra M, Caicedo Y, Padilla N, Millan M . Damage control in penetrating cardiac trauma. Colomb Med (Cali). 2021; 52(2):e4034519. PMC: 8216058. DOI: 10.25100/cm.v52i2.4519. View

13.

Kang N, Hsee L, Rizoli S, Alison P . Penetrating cardiac injury: overcoming the limits set by Nature. Injury. 2009; 40(9):919-27. DOI: 10.1016/j.injury.2008.12.008. View

14.

Ling F, Massey H . Traumatic ventricular septal defect and flail tricuspid valve: successful management by an extracorporeal membrane oxygenator-supported hybrid approach. Catheter Cardiovasc Interv. 2013; 83(4):655-60. DOI: 10.1002/ccd.25035. View

15.

Ijuin S, Inoue A, Takamiyagi Y, Tsukayama H, Nakayama H, Matsuyama S . False negative of pericardial effusion using focused assessment with sonography for trauma and enhanced CT following traumatic cardiac rupture; A case report. Trauma Case Rep. 2020; 28:100327. PMC: 7350087. DOI: 10.1016/j.tcr.2020.100327. View