Delayed Complication of Penetrating Cardiac Injury: Traumatic VSD

The Removal, Excision, Sterilization, and Quarantine (RESQ) Method is a Feasible Alternative Treatment for Cardiac Implantable Electronic Device Infections

Background

Current guidelines recommend that all infected cardiac implantable electronic devices (CIEDs) should be removed. However, financial or anatomical concerns can lead to management of infection with simple debridement, as opposed to complete removal. In this observational study, we report the outcomes of our modified procedure for this real-world dilemma.

Methods and Results

The Quarantine (RESQ) method is characterized as follows: the removal (R) of all non-essential foreign materials, including old sutures and leads; the excision (E) of all non-viable, chronically inflamed, granulation, or scar tissue; the sterilization (S) of the remaining generator; and the quarantine (Q) of a new pocket in the sub-muscular layer for reimplantation. From a review of electronic medical records, 30 patients were selected and divided into three groups according to the intervention used: RESQ (n = 9) in group A, simple debridement (n = 16) in group B, and guideline-recommended replacement (n = 5) in group C. Patient baseline characteristics were similar between the groups. After analyzing the proportion of patients that were free from infection one year following their respective interventions, we found that group A performed better than group B (100% and 31.2% infection-free, respectively, p = 0.001), and was comparable to group C (both 100% infection-free, p = not applicable).

Conclusions

The RESQ method is a feasible and beneficial alternative for selected patients with CIED infections who are unable to receive a generator replacement according to the recommended guideline.

Successful management of a combined cardiopulmonary penetrating injury: a case report

Background

Penetrating thoracic injury is a type of critical illness with a high mortality rate, which often involves the heart, large blood vessels, and lungs. Penetrating cardiac injury is a very serious condition, and most patients die rapidly within minutes due to hemorrhagic shock and acute cardiac tamponade. Due to the critical condition and rapid development of this type of injury, most patients die before reaching the hospital. It is rare in clinical practice and difficult to treat.

Case Description

Our hospital recently admitted a case of penetrating cardiac injury. In this case, a 50-year-old male was admitted to the hospital following “a fall from a height [that] caused steel bar[s] to penetrate the chest cavity for 7 hours before he arrived at the hospital”. The patient fell from a height of 3meters at a construction site, which caused 2 steel bars to penetrate his chest. The patient presented with symptoms such as chest pain, dyspnea, and apathy. Chest computed tomography suggested combined cardiopulmonary penetrating injury. Echocardiography suggested penetrating cardiac injury, and moderate pericardial effusion. After the patient was sent to the Emergency Department of our hospital, the relevant laboratory examinations and an emergency surgery were performed. The rescue team consisting of cardiac surgery, thoracic surgery, anesthesiology, emergency department, and imaging department specified the treatment plan. Under general anesthesia, cardiopulmonary bypass was performed via right femoral arteriovenous cannulation. The steel bars were removed, the left atrial posterior wall and ventricular septal perforation were repaired, and the great cardiac vein was sutured. Coronary artery bypass surgery was performed at the same time, and the anterolateral lung tissue of the left lower lobe was resected. Postoperative treatment was given to prevent against infection and improve cardiopulmonary function. The patient recovered well, and he was discharged from the hospital. The results of the follow-up 1 year after surgery were normal.

Conclusions

Timely treatment and a reasonable operation mode is essential in treating this kind of trauma. A joint diagnosis and treatment by a multidisciplinary team can enable a comprehensive assessment of the condition to be made quickly and an optimal treatment plan to be formulated.