Secondary Lesions of Penetrating Cardiac Injuries

Abstract

Between July 1962 and July 1978, 29 patients )23 male and 6 female) from 17 to 48 years of age were followed from two weeks to 15 years after penetrating cardiac injuries involving right ventricle (12), right atrium (6), left ventricle (8), left atrium (2), and pulmonary conus (1). Thoracotomies were performed on all patients either in the emergency room during resuscitation or in the operating room. Repair of the injuries were carried out. All patients were followed for presence of residual cardiac damage. To our surprise, secondary complications were noted in 15 of the 29 patients as follows: Coronary damage (3), pseudoanuerysm (2), bullet embolus (1), VSD (4), recurrent pericarditis (1), mitral valve injury (2), aorta caval (1), and aorto pulmonary fistula (1). Between July 1962 and July 1974, only symptomatic patients with subjective and objective findings had detailed cardiac evaluations. Eight of 20 patients were found to have secondary cardiac complications. Since July 1974, seven of nine patients underwent a posttraumatic cardiac evaluation. Six of the seven patients were found to have significant cardiac lesions which were unrecognized at the time of initial operation. The incidence of posttraumatic remediable cardiac lesions is probably higher than previously suspected. An aggressive, detailed postoperative evaluation is recommended for all patients with penetrating cardiac injuries.

Postdischarge Complications After Penetrating Cardiac Injury

“…To date, there have only been small case series examining the posttraumatic sequelae after penetrating cardiac injuries. [6][7][8][9][10][11] Reported complications include atrial and ventricular septal defects, valvular incompetence, vascular-cardiac fistulas, ventricular aneurysms, conduction abnormalities, ventricular dysfunction, dilatation or hypertrophy, intramural thrombus, endocarditis, and pericarditis. [6][7][8][9][10][11] These studies are limited by their sample size, wide patient inclusion criteria, and lack of stan-…”

Echocardiographic Demonstration of Multiple Gunshot Pellets in the Heart with Traumatic Cardiac Tamponade

“…The prehospital mortality resulting from penetrating cardiac wounds is reported to range from 30 to 80% [3], In survivors, although late complications are not uncom mon [4], retained intracardiac foreign bodies frequently remain in place for years without causing any further problems [5], Interestingly, following gunshot injury, the late development of lead toxicity has been reported [6], Our patient did suffer complication of delayed cardiac tamponade. Since the source of fever was unclear, the pos sibility of postcardiac injury syndrome needs to be con sidered [7].…”

Recurrent coronary artery fistula

“…, 1981 ;Lowe and Sabiston, 1982;Macri et al, 1982;Meyer et al, 1975;Rittenhouse et ai., 1975;Stanley et al, 1981 ;Theman and Crosby , 1981 Wilde and Watt, 1980). They are usually congenital but they may be iatrogenic due to inadvertent anastomosis of an aortocoronary vein graft to the left anterior descending coronary vein (przybojewski, 1982;Starling et al, 1981), secondary to penetrating or blunt chest injuries (Alter et al, 1977;Austin et al, 1977;Fallahnejad et al, 1980;Pellegrini et al, 1980;Snyder etal., 1978;ThandroyenandMatisonn, 1981;Vemeyre et al, 1979) or rarely to malignancy (Koller et al, 1980). 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.…”