Penetrating thoracic trauma producing cardiac shunts

Management of right coronary artery fistula caused by nail gun trauma

“…Patients may be asymptomatic at the time of initial injury only to develop a murmur or symptoms later such as congestive heart failure, pulmonary hypertension, or endocarditis. 1,2 Intervention should be considered in most if not all patients, particularly in those who are symptomatic. Treatment options include (1) surgical correction with ligation of the coronary artery proximal and distal to the fistula 3 and bypass grafting of the distal vessel, (2) percutaneous closure either with coil embolization, or (3) a covered stent.…”

Recurrent coronary artery fistula

“…Congential coronary fistulae usually drain to the right side of the heart or the coronary sinus resulting in left -toright shunt; however, they may drain into the left atrium or left ventricle producing a picture of aortic regurgitation (from left-to-left shunt) and coronary steal. Although they may be asymptomatic and may remain so for many years or even diminish and close spontaneously (Francis et al, 1979;Lowe et al, 1981;Mahoney et al, 1982) they are frequently associated with symptoms and complications especially during middle and old age (Alter et al, 1977;Austin et al, 1977;Fallehnejad et al, 1980;Koller et al, 1980;Liberthson et al, 1979;Lowe et al, 1981;Lowe and Sabiston, 1982;Macri et al, 1982;Meyer et al, 1975;Pellegrini et al, 1980;Przybojewski, 1982;Rittenhouse et at., 1975;Snyder et al, 1978;Stanley et at., 1981;Starling et al, 1981;Thandroyen and Matisonn, 1981;Theman and Crosby, 1981;Urrutia-S et al, 1983;Vemeyre et al, 1979;Vogelbach et al, 1979;Wilde and Watt, 1980). Symptomatology may be produced by a compromise of coronary perfusion (angina, arrhythmias, dyspnea), or by the left-to-right shunt (dyspnea, atrial tachyarrhythmias, congestive heart failure, pulmonary hypertension).…”

“…The diagnosis, if suspected, may be made 'in the presence of a continuous, systolic, or diastolic murmur and by echocardiography (Chen et al, 1982;Knippel et al, 1982;Sasaki et al, 1981;Thandroyen and Matisonn, 1981;Yoshikawa et al, 1982) but is established by selective coronary arteriography, since aortic sinus fistula, patent ductus arteriosus, ventricular septal defect with aortic insufficiency, and ruptured aneurysm of the sinus of Val salva can mimic fistula. This patient illustrates the importance of this technique since, although he had recurrent chest pain and atrial tachyarrhythmias, he did not have typical findings either by auscultation or M-mode and 2-D echocardiography.…”

Obscure traumatic cardiac lesion after a penetrating chest injury: Review of the literature

“…In 4-20% of them, various forms of intrathoracic shunt were found at the time of evaluation on autopsy. [4][5][6] In the present paper, we report the case of penetrating chest injury.…”