The Role of Heart Team Approach in Penetrating Cardiac Trauma: Case Report and Review of the Literature

Abstract

Penetrating cardiac trauma has been increasing in clinical experience and is joined to important morbidity and mortality. A case of a 38-year-old female with history of postpartum depression was reported, admitted to our department for cardiac tamponade due to penetrating self-inflicted multiple stab wound of the chest complicated by rupture of anterior left ventricular wall and traumatic ventricular septal defect. Following the unstable hemodynamic instability, a combined therapeutic strategy was chosen: surgery and transcatheter implantation to correct free wall ventricle damage and traumatic ventricular septal defect, respectively.

Penetrating and blunt injuries of the heart - an abdominal surgeon’s personal experience in Serbia

“…Echocardiography, if allowed by hemodynamic stability, is very useful in detecting trauma of the heart [28]. One of very informative, but time consuming, diagnostic procedure, heart catheterization is, by some authors, not necessary in the initial phase of diagnostic [4], but is very important in solving complex injuries [22], and practically mandatory in post-surgical phase, in order to exclude secondary complications [22], which can be expected in up to 10% of cases [4].…”

“…The role of general surgeons in heart trauma, in the era of modern cardiac surgery Several authors published results of specialized centers in managing heart wounds, combining interventional, radiologic and also surgical approach [19][20][21][22]. It is obvious that diagnosis that is made swiftly and very early, with an organized and available heart team (interventional cardiologists, radiologists and cardiac surgeons), which are available in specialized centers, provide favorable results [4,22]. In some parts of the world, where trauma and cardiothoracic surgeons are not easily available, penetrating thoracic trauma is becoming more frequent, also the need for thoracotomy [10,23].…”

Lifesaving Emergency Sternotomy in Traumatic Cardiac Tamponade in a Teaching Hospital in Ghana: Survival of Two Rare Cases

“…Median sternotomy is the documented gold standard approach for evaluation of patients with cardiac injuries because it offers extensive access to the heart, great vessels and the pleural cavities. However, a left anterolateral thoracotomy incision is a faster and simpler approach easily utilized in emergency department thoracotomy for unstable patients who go into arrest and would benefit from an open chest cardiac massage since it provides easy access to the ventricles and pulmonary arteries [10]. We used median sternotomy for both patients because of the gunshots on the precordium with the suspicion of cardiac injuries which were confirmed intraoperatively with the second patient having a right ventricular perforation.…”

Penetration cardiac wound associated with anterior mitral leaflet perforation: a case report and review of the literature

“…В дополнение к травмам свободной стенки сердца или магистральных артерий при проникающих ранениях сердца могут страдать МЖП, межпредсердная перегородка, сердечные клапаны, проводящая система и коронарные артерии [13,14,17,19]. Частота повреждения внутрисердечных структур у пациентов после ранения сердца существенно варьирует: от 4 до 56% в зависимости от исследования, при этом наиболее часто повреждается МЖП, реже встречается травма атриовентрикулярных или полулунных клапанов [5,16,33].…”

“…Хирургическое вмешательство необходимо в случае гемодинамически значимых повреждений. Наиболее часто вмешательство проводится по поводу дефектов мышечной части МЖП как традиционным открытым хирургическим способом с доступом к входному и выходному отверстиям раневого канала через различные камеры сердца или магистральные сосуды в условиях искусственного кровообращения [6,10,17,36,48,[50][51][52][53][54][55][56][57][58], так и посредством чрескожной транскатетерной имплантации современных окклюдеров [33,45,[59][60][61][62][63].…”