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Undetected Aorto-RV Fistula With Aortic Valve Injury and Delayed Cardiac Tamponade following a Chest Stab Wound: A Case Report.

Esfahanizadeh J, Abbasi Tashnizi M, Moeinipour AA, Sepehri Shamloo A - Trauma Mon (2013)

Bottom Line: Although a few patients will survive after penetrating cardiac injuries, some of them may have unnoticeable intracardiac injuries.To prevent missing intracardiac injury and also late cardiac injury complications, in all pericordial stab wounds, serial clinical examinations and serial echocardiography should be performed.In addition, cardiac injuries should be repaired during the same hospital stay.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiac Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran.

ABSTRACT

Introduction: Although a few patients will survive after penetrating cardiac injuries, some of them may have unnoticeable intracardiac injuries. The combination of aorto-right ventricular fistula with aortic valve injury is rare.

Case presentation: A 19 year-old man referred with an aorto-right ventricular fistula accompanied with aortic regurgitation and delayed tamponade following a stab in the chest. The patient was scheduled for fistula repair, aortic valve replacement and pericardectomy two months after trauma.

Conclusions: To prevent missing intracardiac injury and also late cardiac injury complications, in all pericordial stab wounds, serial clinical examinations and serial echocardiography should be performed. In addition, cardiac injuries should be repaired during the same hospital stay.

No MeSH data available.


Related in: MedlinePlus

Aortic view of Aorto-RV Fistula (Arrow)
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fig5290: Aortic view of Aorto-RV Fistula (Arrow)

Mentions: A 19-year -old healthy man, who sustained a single stab wound (1.5cm knife wound in the left 4th intercostal space para-sternally) was admitted to a local hospital. To manage hemopnumothorax, a chest tube was inserted and after 3 days the patient was discharged without any symptoms. At that time, because of no observed cardiac symptoms or signs, cardiac injury was not suspected by the general surgeon, thus, no cardiac evaluation such as echocardiography or thoracic computed tomography (CT) scan was performed. Two months later, he referred to evaluate dyspnea. He had severe shortage of breath and distending jugular veins. Lung sounds were clear but heart sounds were decreased and a continuous murmur was heard at the left sternal border (BP = 85/40mmHg, PR = 135/min, RR = 35/min, T = 38.5οC). In addition, the electrocardiogram showed sinus tachycardia, and the chest roentgenogram indicated an increased cardiac silhouette that was globular. Transthoracic echocardiography confirmed a massive pericardial effusion. Also, severe aortic regurgitation caused by right coronary cusp perforation and a defect between the right Valsalva sinus and right ventricle (RV) were demonstrated. The patient was scheduled for an urgent operation for post traumatic delayed tamponade and also intracardiac defects. After median sternotomy, a thickened and inflamed pericardium (4mm) which was full of debris and old clots was noticed. In addition, the epicardium was edematous with some adhesions. About 800cc sanguineous fluid was evacuated. Specimens of pericardial tissue and fluid were sent for culturing. Then, using aorto-bicaval cannulation, cardiopulmonary bypass and cardiac arrest were done. After aortotomy, a 10mm perforation in the right coronary cusp was found (Figure 1). Moreover; a 7mm defect in the right coronary sinus that opened into the RV was revealed (Figure 2).


Undetected Aorto-RV Fistula With Aortic Valve Injury and Delayed Cardiac Tamponade following a Chest Stab Wound: A Case Report.

Esfahanizadeh J, Abbasi Tashnizi M, Moeinipour AA, Sepehri Shamloo A - Trauma Mon (2013)

Aortic view of Aorto-RV Fistula (Arrow)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3860677&req=5

fig5290: Aortic view of Aorto-RV Fistula (Arrow)
Mentions: A 19-year -old healthy man, who sustained a single stab wound (1.5cm knife wound in the left 4th intercostal space para-sternally) was admitted to a local hospital. To manage hemopnumothorax, a chest tube was inserted and after 3 days the patient was discharged without any symptoms. At that time, because of no observed cardiac symptoms or signs, cardiac injury was not suspected by the general surgeon, thus, no cardiac evaluation such as echocardiography or thoracic computed tomography (CT) scan was performed. Two months later, he referred to evaluate dyspnea. He had severe shortage of breath and distending jugular veins. Lung sounds were clear but heart sounds were decreased and a continuous murmur was heard at the left sternal border (BP = 85/40mmHg, PR = 135/min, RR = 35/min, T = 38.5οC). In addition, the electrocardiogram showed sinus tachycardia, and the chest roentgenogram indicated an increased cardiac silhouette that was globular. Transthoracic echocardiography confirmed a massive pericardial effusion. Also, severe aortic regurgitation caused by right coronary cusp perforation and a defect between the right Valsalva sinus and right ventricle (RV) were demonstrated. The patient was scheduled for an urgent operation for post traumatic delayed tamponade and also intracardiac defects. After median sternotomy, a thickened and inflamed pericardium (4mm) which was full of debris and old clots was noticed. In addition, the epicardium was edematous with some adhesions. About 800cc sanguineous fluid was evacuated. Specimens of pericardial tissue and fluid were sent for culturing. Then, using aorto-bicaval cannulation, cardiopulmonary bypass and cardiac arrest were done. After aortotomy, a 10mm perforation in the right coronary cusp was found (Figure 1). Moreover; a 7mm defect in the right coronary sinus that opened into the RV was revealed (Figure 2).

Bottom Line: Although a few patients will survive after penetrating cardiac injuries, some of them may have unnoticeable intracardiac injuries.To prevent missing intracardiac injury and also late cardiac injury complications, in all pericordial stab wounds, serial clinical examinations and serial echocardiography should be performed.In addition, cardiac injuries should be repaired during the same hospital stay.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiac Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran.

ABSTRACT

Introduction: Although a few patients will survive after penetrating cardiac injuries, some of them may have unnoticeable intracardiac injuries. The combination of aorto-right ventricular fistula with aortic valve injury is rare.

Case presentation: A 19 year-old man referred with an aorto-right ventricular fistula accompanied with aortic regurgitation and delayed tamponade following a stab in the chest. The patient was scheduled for fistula repair, aortic valve replacement and pericardectomy two months after trauma.

Conclusions: To prevent missing intracardiac injury and also late cardiac injury complications, in all pericordial stab wounds, serial clinical examinations and serial echocardiography should be performed. In addition, cardiac injuries should be repaired during the same hospital stay.

No MeSH data available.


Related in: MedlinePlus