Management of extensive right ventricular injury or rupture

Acellular cadaveric dermis (Alloderm) for ventricular coverage after a gunshot wound

“…1 Other authors have reported ventricular aneurysm or rupture after primary closure or after reinforcement of primary closure. 3,16,17 Despite using Alloderm for coverage of the ventricular defect, our patient remains at increase risk of developing a ventricular aneurysm. Due to the morbidity of this type of injury, a strict follow up schedule is necessary to recognise any further weakening of the repair (i.e.…”

“…5 Even if technically complex surgery may be done, the prognosis remains poor. 16,17 The management of penetrating cardiac injuries in the setting of a patient with multiple gunshot wounds along with multiple organ injuries poses a challenge for the trauma surgeon. In our patient, once haemostasis of the left ventricle was achieved, we proceeded with the abdominal exploration.…”

Post-Mediastinitis Ventricle Rupture:. Closing the Chest Without Closing the Heart?

“…Several authors suggest that the initial surgical debridement should include an extensive slitting up of the left side of the sternum to free the right ventricle from any chest wall adhesions and to decrease the pulling tension during chest wall movement 2,4 . When right ventricle rupture occurs, the previously described surgical management is complex and includes a four‐step procedure: first, use of femoral‐femoral cardiopulmonary bypass; second, mediastinum exploration and release of chest wall adhesions; third, repair of the right ventricle tearing, and fourth, wound closure 5,6 . However, detaching the heart from the chest wall may be hazardous in case of a coronary artery bypass graft using the mammary artery, which is frequent.…”

“…2,4 When right ventricle rupture occurs, the previously described surgical management is complex and includes a fourstep procedure: first, use of femoral-femoral cardiopulmonary bypass; second, mediastinum exploration and release of chest wall adhesions; third, repair of the right ventricle tearing, and fourth, wound closure. 5,6 However, detaching the heart from the chest wall may be hazardous in case of a coronary artery bypass graft using the mammary artery, which is frequent. Furthermore, repair of the ventricular wall with rectus fascia or Teflon during cardiopulmonary bypass and primary or secondary wound closure using pectoral myoplasty, omentoplasty, or muscle flap are heavy methods in an emergency situation.…”

Spontaneous Right Ventricular Disruption Following Treatment of Sternal Infection

“…The published mortality rate ranges between 0% and 100%. [1][2][3][4][5][6][7][8][9][10][11] The exact incidence is unknown, but several authors have suggested that RVD occurs in 0.8 to 14.6% of the cases of mediastinitis. 6,7 A review of the surgical literature reveals a total of 39 patients.…”