Thorac Cardiovasc Surg 2000; 48(6): 373-375
DOI: 10.1055/s-2000-8339
Case Report
© Georg Thieme Verlag Stuttgart · New York

Absence of Hemodynamic and ECG Changes in a Patient with Traumatic Left Ventricular Injury and Puncture of the Left Anterior Descending Branch

M.  Südkamp, H.  J.  Geissler, E.  R.  de Vivie
  • Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
Further Information

Publication History

Publication Date:
31 December 2000 (online)

Patients with penetrating cardiac injury usually present with cardiac tamponade and shock upon hospital arrival. However, absence of hemodynamic depression does not exclude a potentially fatal injury of the heart: This article reports on a patient who developed neither hemodynamic depression nor ECG changes for several hours, despite two left ventricular lacerations with puncture of the LAD. Echocardiography is advocated as the diagnostic tool of choice, and it is emphasized that no penetrating objects should be removed from the wound before surgical access to the heart is established, as this may result in the sudden development of cardiac tamponade.

References

  • 1 Asensio J A, Berne J D, Demetriades D. et al . One hundred five penetrating cardiac injuries: a 2-year prospective evaluation.  J Trauma.. 1998;  44 1073-82
  • 2 Knott-Craig C J, Dalton R P, Rossouw G J, Barnard P M. Penetrating cardiac trauma: Management strategy based on 129 surgical emergencies over 2 years.  Ann Thorac Surg.. 1992;  53 1006-9
  • 3 Mitchell M E, Muakkassa F F, Poole G V, Rhodes R S, Griswold J A. Surgical approach of choice for penetrating cardiac wounds.  J Trauma.. 1993;  34 17-20
  • 4 Tavares S, Hankins J R, Moulton A L. et al . Management of penetrating cardiac injuries: the role of emergency room thoracotomy.  Ann Thorac Surg.. 1984;  38 183-7
  • 5 Juvin P, Brion F, Teissiére F, Durigon M. Prolonged activity after an ultimately fatal gunshot wound to the heart.  Am J Forensic Med Pathol.. 1999;  20 10-2
  • 6 Rozycki G S, Feliciano D V, Ochsner M G. et al . The role of ultrasound in patients with possible penetrating cardiac wounds: a prospective multicenter study.  J Trauma.. 1999;  46 543-51

Received for Publication: February 2, 2000

M.D. Michael Südkamp

Klinik für Herz- und Thoraxchirurgie Universität zu Köln

Joseph-Stelzmann-Straße 9

50924 Köln

Germany

Phone: ++49 221 478 4128

Fax: ++49 221 478 4186

Email: michael.suedkamp@medizin.uni-koeln.de