False negative of pericardial effusion using focused assessment with sonography for trauma and enhanced CT following traumatic cardiac rupture; A case report

Severe left-to-right shunting from combined traumatic tricuspid valve rupture and atrial septal defect: bridge to surgical repair using veno-venous ECMO

Our patient presented to the emergency room following a motor vehicle accident. The traumatic tricuspid valve rupture was diagnosed by transthoracic echocardiogram, and his respiratory status declined rapidly. He was placed on veno-venous extracorporeal membrane oxygenation (VV ECMO) to bridge him to surgical repair. Transoesophageal echocardiography revealed a large atrial septal defect (ASD) with the combination of both injuries leading to severe left-to-right shunting that was underappreciated in the initial management of the patient. The tricuspid valve and the ASD were repaired. In this patient, in the context of both tricuspid valve rupture and ASD, veno-arterial ECMO or percutaneous right ventricular assist devices may have also helped bridge the patient to surgical repair of his blunt cardiac injuries.

Penetrating cardiac injuries: What you need to know

ABSTRACT

Despite significant advances in trauma surgery in recent years, patients sustaining penetrating cardiac injuries still have an overall survival rate of 19%. A substantial number of deaths occur at the scene, while approximately 40% of those reaching trauma centers survive. To increase survival, the key factor is timely intervention for bleeding control, pericardial tamponade release, and definitive repair. Asymptomatic patients sustaining precordial wounds or mediastinal gunshot wounds should be assessed with chest ultrasound to rule out cardiac injuries. Shock on admission is an immediate indication of surgery repair. Patients admitted in posttraumatic cardiac arrest may benefit from resuscitative thoracotomy. The surgical team must be assured that appropriate personnel, equipment, instruments, and blood are immediately available in the operating room. A left anterolateral thoracotomy, which can be extended to a clamshell incision, and sternotomy are the most common surgical incisions. Identification of cardiac anatomical landmarks during surgery is vital to avoid complications. There are several technical options for bleeding control, and the surgeon must be trained to use them to obtain optimal results. Ultimately, prioritizing surgical intervention and using effective resuscitation strategies are essential for improving survival rates and outcomes.

Management of contained penetrating cardiac injury in a patient with prior cardiac surgery

Penetrating cardiac injuries usually require emergent surgical intervention. Our patient presented to the trauma centre with multiple stab wounds to the neck, chest, epigastric region and abdomen. She arrived haemodynamically stable, and her initial Focused Assessment with Sonography for Trauma exam was negative. Her chest X-ray did not show any evident pneumothorax or haemothorax. Due to her injury pattern, she was taken to the operating room for exploratory laparotomy and neck exploration. Postoperatively, she was taken for CT and found to have a contained cardiac rupture. The injury was contained within previous scar tissue from her prior cardiac surgery. Further evaluation revealed that the injury included a penetrating stab wound to the right ventricle and a traumatic ventricular septal defect (VSD). She subsequently underwent a redo sternotomy with the repair of the penetrating stab wound and the VSD. Cardiology, intensive care, trauma surgery and cardiothoracic surgery coordinated her care from diagnosis, management and recovery. This case highlights the challenges in the management of cardiac injuries and the benefits of a multidisciplinary approach to care for complex cardiac injuries.