Repair of pulmonary vein rupture after deceleration injury

Varghese, Delvin; Patel, Hitesh; Cameron, E.; Robson, M

doi:10.1016/s0003-4975(00)01199-1

Cited by 24 publications

(8 citation statements)

References 2 publications

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“…3 Patients can be deceptively stable after a pulmonary vein rupture as the left atrium and pulmonary venous circulation is a low pressure, low impedance system. 2 The resulting low pressure haemothorax in the pleural cavity effectively functions as a giant left atrium, allowing the maintenance of haemodynamics. 2 Retention of the haemothorax in the pleural cavity without drainage and manoeuvres such as drain clamping or blocked drains due to clot is cited as a reason why patients survive to operative repair of this injury.…”

Section: Discussionmentioning

confidence: 99%

“…2 Retention of the haemothorax in the pleural cavity without drainage and manoeuvres such as drain clamping or blocked drains due to clot is cited as a reason why patients survive to operative repair of this injury. 2 The collapsed lung around the hilum with haemothorax (Fig 1) probably saved our patient, preventing immediate exsanguination, allowing time for resuscitation, assessment and transfer to theatre for definitive treatment.…”

Section: Discussionmentioning

confidence: 99%

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Surgical repair of pulmonary vein injury from blunt trauma

Nwaejike

Mosca

Hooper

et al. 2015

annals

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Pulmonary vein deceleration injury is rare and patients can be deceptively stable for a period after injury. Quick diagnosis and transfer to the operating theatre is the only way to treat this potentially lethal injury successfully. Techniques of repair are a useful addition to the cardiovascular surgeon's repertoire. KEYWORDSPulmonary vein -Left atrial wall -Left atrium -Deceleration injury -Cardiopulmonary bypass Case HistoryA 24-year-old male car driver was admitted following a head-on collision with a tree at unknown speed. The front seat passenger was pronounced dead at the scene. (Neither were wearing seatbelts.) On extraction from the car, the driver had a Glasgow coma scale score of 3 so he was intubated and stabilised with a blood pressure of 125/80mmHg and a pulse rate of 90bpm. In the emergency room, a right haemothorax was diagnosed and a chest drain inserted. Two litres of blood were drained and computed tomography showed a right haemopneumothorax (Fig 1), an undisplaced left lateral clavicular fracture, left inferior pubic ramus and acetabular fractures. Owing to continued drainage from the right chest requiring massive colloid transfusion, he was taken to theatre for definitive treatment.The patient was positioned in the right thoracotomy position and via the sixth intercostal space, copious amounts of clot were evacuated. Bleeding from the inferior pulmonary vein was identified with partial avulsion of the vein from the left atrium. No other intrathoracic injuries were identified. The decision was made to repair this on cardiopulmonary bypass (CPB). With the right hilum packed with swabs, the right groin was exposed and the right common femoral artery and vein were identified. CPB was commenced via a 22Fr Thin-Flex single stage venous cannula (Edwards, Irvine, CA, US) in the right femoral vein and the return was via a 16Fr Fem-Flex II (Edwards) in the right femoral artery.A curved DeBakey clamp was applied to the left atrium; the right main pulmonary artery was snared to ensure a bloodless field and further assessment showed a complex avulsion of the right inferior pulmonary vein extending into the left atrium, which was almost completely circumferential. The tip of the tear reached just beneath the right superior pulmonary vein. In order to improve venous return and decompress the heart, a two-stage venous cannula was placed in the right atrium and connected to the femoral vein cannula via a Y-connector. The ascending aorta was crossclamped and under cardioplegic arrest, the left atrial clamp was removed to allow further assessment. It confirmed the complex nature of the pulmonary vein avulsion.The inferior vein was avulsed almost circumferentially with extension to the superior vein and also into the left atrium. The intra-atrial tear was repaired primarily and a porcine pericardial patch (Vascutek, Inchinnan, UK) was used to repair the anterior part of the avulsion on the left atrium, maintaining patency to the right inferior pulmonary vein (Fig 2). After routine deairing manoeuvres,...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Surgical repair of pulmonary vein injury from blunt trauma

Nwaejike

Mosca

Hooper

et al. 2015

annals

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“…Traumatische Verletzungen der Vv. pulmonales, isoliert oder als Kombinationsverletzung, sind äußerst selten [25]. Zielsetzung der chirurgischen Versorgung muss es sein, die Venenverletzung durch eine entsprechende Naht zu versorgen.…”

Section: Das Risiko Einer Zweizeitigen Tödlichen Ruptur Ist Bei Endovunclassified

Traumatische Gefäßverletzungen

Bischoff

Orend

2015

Gefässchirurgie

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Diese Fortbildungseinheit steht Ihnen als e.CME und e.Tutorial in der Springer Medizin e.Akademie zur Verfügung. -e.CME: kostenfreie Teilnahme im Rahmen des jeweiligen Zeitschriften abonnements -e.Tutorial: Teilnahme im Rahmen des e.MedAbonnements ZertifizierungDiese Fortbildungseinheit ist mit 3 CME Punkten zertifiziert von der Landesärzte kammer Hessen und der Nord rheinischen Akademie für Ärztliche Fort und Weiter bildung und damit auch für andere Ärzte kammern anerkennungsfähig. Hinweis für Leser aus Österreich und der SchweizÖsterreich: Gemäß dem Diplom FortbildungsProgramm (DFP) der Öster reichischen Ärztekammer werden die in der e.Akademie erworbenen CMEPunkte hierfür 1:1 als fachspezifische Fortbildung anerkannt. Schweiz: Gefässchirurgie ist durch die Schweizerische Gesellschaft für Gefäßchi rurgie mit 3 Credits pro Modul anerkannt. Kontakt und weitere Informationen

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“…These patients commonly present with hypotension, hypovolemia, and massive hemothorax (9). As with superior vena cava injuries, pulmonary vein injuries can be intrapericardial or extrapericardial; the former type is associated with hemopericardium with or without cardiac tamponade, depending on the presence of a pericardial tear, and the latter type is associated with hemothorax (8).…”

Section: Pulmonary Veinmentioning

confidence: 99%

Multidetector CT of Blunt Traumatic Venous Injuries in the Chest, Abdomen, and Pelvis

Holly¹,

Steenburg²

2011

RadioGraphics

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Venous injuries as a result of blunt trauma are rare. Even though current protocols for multidetector computed tomography (CT) of patients with trauma are designed to evaluate primarily the solid organs and arteries, blunt venous injuries may nevertheless be identified, or at least suspected, on the basis of the multidetector CT findings. Venous injuries are associated with high morbidity and mortality rates. Diagnosis of a possible venous injury is crucial because the physical findings of a venous injury are nonspecific and may be absent. This article aims to make the radiologist aware of various venous injuries caused by blunt trauma and to provide helpful hints to aid in the identification of venous injuries. Multidetector CT technology, in combination with interactive manipulation of the raw dataset, can be useful in the creation of multiplanar reconstructed images and in the identification of a venous injury caused by blunt trauma. Familiarity with direct and indirect signs of venous injuries, as well as with examples of blunt traumatic venous injuries in the chest, abdomen, and pelvis, will help in the diagnosis of these injuries.

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Repair of pulmonary vein rupture after deceleration injury

Cited by 24 publications

References 2 publications

Surgical repair of pulmonary vein injury from blunt trauma

Surgical repair of pulmonary vein injury from blunt trauma

Traumatische Gefäßverletzungen

Multidetector CT of Blunt Traumatic Venous Injuries in the Chest, Abdomen, and Pelvis

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