Off-pump cardiac revascularization after a complex stab wound

Bowley, Douglas M.; Saeed, M. A.; Somwe, Dominique; Boffard, Kenneth D.; Naidoo, Krubin; Davis, Steve C

doi:10.1016/s0003-4975(02)04106-1

Cited by 17 publications

(8 citation statements)

References 12 publications

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“…With developments of stabilizing devices and intracoronary artery shunts, which enhance exposure, the off-pump repair for coronary artery injuries has been reported. [3][4][5] In our case, a complex coronary artery injury and delayed LV rupture was successfully treated without the use of CPB.…”

Section: Discussionmentioning

confidence: 71%

“…However, proximal and middle injury of major arteries, particularly the LAD and right coronary arteries, which is often associated with an unstable hemodynamic condition, or cardiac chamber injuries, require CABG with or without cardiopulmonary bypass (CPB). [1][2][3][4][5] The role of CPB in these patients depends on the homodynamic stability of the patient and associated intracardiac injuries such as mitral valve injury or ventricular septal defect. 1,2 Without the use of CPB, CABG, or ventricular repair has been selectively reported.…”

Section: Discussionmentioning

confidence: 99%

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Off-Pump Repair of LAD Transection and LV Rupture for Cardiac Stab Wound

Park

Moon²,

Yoon³

et al. 2008

Journal of Trauma: Injury, Infection &Amp; Critical Care

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P enetrating cardiac injury (PCI) is associated with a high mortality because of hemorrhage and/or possible cardiac tamponade that occurs at the prehospital stage or in the Emergency Department (ED). 1,2 However, an early diagnosis by echocardiography and the physician's increased awareness of the possibility of major cardiac injury has a key role in improving the survival rate. In a nonelective setting, off-pump repair will be an alternative for treatment of PCI. CASE REPORTA 23-year-old woman was brought to the ED with multiple stab wounds. On her arrival, she was hemodynamically unstable, which was persistent even after fluid and blood resuscitation. Multiple wounds were explored at the ED, and this examination revealed the stab wound below left nipple was so deep that a small pericardial defect could be palpated.Under a double-lumen endotracheal anesthesia, a left anterior thoracotomy skin incision was performed with the patient placed in the semilateral decubitus position. No active bleeders were found and pericardial cavity was profusely irrigated with warm saline. During irrigation, pulsating bleeding suddenly came from the proximal part of LAD, which was found after upward extension of pericardial opening. With an assistant compressing the bleeding site with his finger, a median sternotomy was quickly performed.The LAD transection was noticed after the artery gives rise to first diagonal branch. Because only marginal cardiac function would be expected after ligation, a decision for CABG was taken. The myocardial stabilizer (Guidant Corp, Cupertino, Calif.) was applied to the area of the LAD, and proximal end of LAD was ligated with a 5-0 polyprophylene suture. With a 7-0 polyprophylene suture, a segment of saphenous vein was anastomosed with the distal end in the end to end manner.For the proximal anastomosis, a partial occlusion clamp was placed over the ascending aorta. Suddenly and dramatically, active bleeding came from the anterior wall of LV near the transected LAD, which was made by unnoticed stab wound. This was considered as an effect of delayed LV rupture because of the sudden rise of LV afterload by the application of a partial occlusion clamp. The clamp was promptly released and the vigorous bleeding was controlled by gentle finger compression. The better exposure and observation of the rupture site was obtained after the gauze was placed back to the LV. The first mattress suture of 3-0 polyprophylene reinforced with Teflon pledget was placed in the middle of transverse rupture site of about 3.5 cm in length. Additional four mattress stitches were applied for secure closure. Once again, the ascending aorta was clamped for proximal anastomosis, and then active bleeding came from among the stitches. Additional stitches were applied for hemostasis.We decided to use left internal mammary artery (LIMA) for a proximal anastomosis. An end-to-end anastomosis was made between a segment of the saphenous vein and LIMA.After the operation, the patient recovered uneventfully, and the postoperative coronary...

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Off-Pump Repair of LAD Transection and LV Rupture for Cardiac Stab Wound

Park

Moon²,

Yoon³

et al. 2008

Journal of Trauma: Injury, Infection &Amp; Critical Care

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“…The therapeutic approach consists of vessel repair, specifically, artery ligation or aortocoronary bypass [16]. Echocardiography is considered to be the first diagnostic approach on initial assessment and follow-up, especially in hemodynamically stable patients [13], but it is not infallible [9], as in this case.…”

Section: Discussionmentioning

confidence: 97%

Fatal delayed cardiac tamponade due to rupture of micropseudoaneurysm of left anterior descending coronary artery following stab to the chest

Xing

Zou

et al. 2015

Cardiovascular Pathology

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“…Mortality rates of patients with coronary artery injuries surviving to care have improved since the introduction of CABG with cardiopulmonary bypass [9][10][11]. Recently, OPCAB has been applied to this injury with considerable success [3,[5][6][7][8] As demonstrated by these two reported cases, the details of the clinical presentation will usually determine the surgical approach in patients with salvageable cardiac injury [12]. In addition, ultrasonographic (FAST) examination has proven to be quite reliable in assessing intrathoracic or intraperitoneal injuries following penetrating anterior chest trauma [13].…”

Section: Discussionmentioning

confidence: 99%

“…Even with the introduction of coronary artery bypass grafting to ameliorate myocardial ischemia following coronary ligation, results remained unfavorable [2]. However, several reports have recently indicated initial successes with coronary bypass grafting performed without the benefit of cardiopulmonary bypass and myocardial arrest [3,[5][6][7][8]. We report two recent cases of penetrating cardiac injuries with coronary artery lacerations treated with ligation and off-pump coronary artery bypass (OPCAB).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2009

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Coronary artery injuries are rare but highly lethal. Debate exists as to the best treatment for this complex set of injuries, with historical treatment favoring arterial ligation. Although conventional coronary artery bypass grafting using cardiopulmonary bypass has been used somewhat successfully, enthusiasm for off-pump CABG (OPCAB) has grown more recently. We report two unique cases of left anterior descending coronary arterial injuries managed successfully with OPCAB.

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Off-pump cardiac revascularization after a complex stab wound

Cited by 17 publications

References 12 publications

Off-Pump Repair of LAD Transection and LV Rupture for Cardiac Stab Wound

Off-Pump Repair of LAD Transection and LV Rupture for Cardiac Stab Wound

Fatal delayed cardiac tamponade due to rupture of micropseudoaneurysm of left anterior descending coronary artery following stab to the chest

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

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