Mitral valve regurgitation and endocarditis triggered by a needle.

BACKGROUND: Cardiac foreign bodies are extremely rare in clinical patients, especially when foreign bodies damage the internal structure of the heart coincidentally after they penetrate the heart. CASE PRESENTATION: Here, we report the case of a two-year-old girl whose heart was penetrated by a needle, which triggered mitral valve regurgitation and endocarditis. After a comprehensive inspection, accurate judgment and surgical preparation, we removed the needle and repaired her mitral valve. Fortunately, she recovered postoperatively. CONCLUSION: From this case, we can know that when cardiac foreign bodies are suspected, ultrasound is an important inspection method. Moreover, the approaches for handling each such case are different depending on the associated injuries.

Abdominal Aorta Bullet Embolism: Presentation and Management.

Penetrating cardiac injury (PCI) secondary to a gunshot wound presents with several complications and a mortality rate of 94% before reaching the hospital. Current literature search reveals that embolism of bullet fragments after gunshot wounds are exceptionally rare. Additionally, no reported case was found regarding bullet embolism following left atrium penetration at the time of this case report. This case describes a 34-year-old male who presented to a level I trauma center after sustaining a gunshot wound to the posterior torso. Imaging demonstrated several fragments in the mid-thoracic region in addition to the primary bullet fragment located within the aorta at the bifurcation of the iliac arteries likely due to left atrial penetration and subsequent embolization.

Inferior Vena Cava Filter Migrated to Left Ventricle.

Inferior vena cava (IVC) filters have been widely used to prevent pulmonary emboli in patients with venous thromboembolism. Here we report a rare case of complete pericardial tamponade with severe mitral and tricuspid valve regurgitation due to a fractured IVC filter. A 38-year-old male came to our emergency department with a 19-day history of progressive chest tightness. Chest x-ray revealed a tethering catheter fractured at the level of the junction of the superior vena cava and the right atrium. We performed open surgery and discovered that a steel wire had punctured the atrioventricular septum, the mitral valve, and finally the posterior wall of the left ventricle. The patient recovered quite well and was discharged after 1 week.

Left atrium perforation with lung injury after catheter ablation.

Left atrial perforation is a known complication following pulmonary vein catheter ablation. Our case of a 62-year-old female underwent urgent surgery for repair of left atrium perforation with left pleural effusion as a late complication after multiple transcatheter radiofrequency pulmonary vein ablations for persistent atrial fibrillation.

Heparineless off-pump coronary artery bypass in a patient with gunshot wound to chest and heart.

OBJECTIVES: Administration of heparin is standard in coronary artery bypass grafting (CABG) with or without cardiopulmonary bypass (OPCABG). In some circumstances, the risk of heparinization may outweigh its benefits, and there is scarce literature on how to proceed in these cases. We describe the technique used for OPCABG without heparin. METHODS: We report the case of a patient with a gunshot wound to the chest resulting in multiple lung lacerations and transection of the proximal left anterior descending coronary artery (LAD) leading to hemorrhagic shock with tamponade, and cardiogenic shock due to myocardial ischemia who received OPCABG without heparin. RESULTS: A 23-year-old patient suffered multiple gunshot wounds to the chest and was admitted in shock with massive left hemothorax. Emergency left thoracotomy revealed multiple lung lacerations and transection of the proximal left anterior coronary artery. The patient presented acute myocardial ischemia and progressed to cardiogenic shock requiring insertion of intra-aortic balloon pump (IABP) to try to support hemodynamics. OPCABG with a segment of reversed saphenous vein graft to the LAD coronary artery was performed using standard techniques but without heparinization. The graft was flushed with normal saline before completing both anastomosis. Myocardial ischemic changes reversed, and the patient stabilized immediately after completing OPCABG, allowing to wean off IABP in the operating room. Postoperative recovery was unremarkable, and the patient was discharged home on postoperative day 9. CONCLUSION: Benefits of OPCABG include decreased bleeding and lower requirement of blood transfusions. This experience shows that OPCABG can be performed without systemic heparinization in selected cases.

"Mending A Broken Heart!" (a few technical tips on repairing penetrating trauma to the heart).

During the history operative repair of cardiac injuries was considered to be unmanageable and the first successful cardiomiorraphy was performed just around a century ago. Tamponade, more frequently than exsanguination are cause of death in penetrating cardiac trauma. This is a usualy lethal injury and those surviving to hospital have an overall mortality approaching 80%. The penetrating injury require some basic steps, not special operative dexterity. We present the technical management of this injury, certain danger points and pitfalls. Options for surgical exposure, technical details of suturing cardiac injuries, and exceptional conditions such as injury near the coronary artery are discussed in detail. Outcome data and future directions in managing this injury are also examined.

Pulmonary Artery Bullet Embolism following Cardiac Gunshot Wound.

Penetrating chest trauma is common but few need surgical treatment (10-20%). The mortality of gunshot wounds of the heart is 45%, among the wounded arriving at the hospital. The suspicion of wound heart with an inlet in the heart area (limited by costal awnings down, clavicles top, and mid-clavicular line outside) and pericardial effusion remains a surgical indication. Gunshot wounds of the heart with migration of the projectile in the pulmonary artery are rare. Migration of projectile into the pulmonary artery is described most often with lesions of peripheral veins without concomitant cardiac involvement. The indication of projectile extraction is not clearly defined in the literature. Conservative management of selected cases of pulmonary artery bullet emboli may be warranted in light of the risks of extraction.

Interesting case of a sewing needle inside the heart: report of a case.

Despite being rarely seen, penetrating cardiac injuries are clinically significant, as they are highly lethal. We herein present the case of a 3-year-old male who unintentionally injured himself by pricking his own chest with a sewing needle and introducing it through the left-lower margin of his sternum into his right ventricle. The needle was located anterior-posteriorly over the right ventricle. An anterior thoracotomy was performed, and the needle was safely removed. No hemorrhage or arrhythmia was seen, so the operation was ended. An early diagnosis and intervention proved to be life-saving for this penetrating cardiac injury.

Management of malignant middle cerebral artery infarction following a cardiac stab wound--the role of early decompressive craniectomy.

We report the presentation, investigation and management of a 22-year-old male who developed a right malignant middle cerebral artery infarct following a cardiac stab wound. This case exemplifies that early identification and timely decompression of young patients with embolic infarcts as a result of penetrating trauma can lead to a favourable clinical outcome.

[Combined gunshot injuries of the heart and lungs]. / Kombinierte Schussverletzung des Herzens und der Lunge.

The authors present a case report of a 38-year-old man who suffered combined gunshot injuries of the heart and lungs from a small caliber gun. The gunshot resulted in combined injuries of a penetrating wound of the left lung, the right heart chambers and the right lung which were successfully managed despite a delay in surgery of several hours by pledget sutures of the heart wounds, wedge resection of the lingula and right lower lung lobectomy performed via a clamshell thoracotomy.

Delayed detection of a ventricular septal defect following penetrating trauma.

This is a case report of a 27-year-old male who sustained a stab wound to the chest with a resulting penetrating cardiac injury and subsequent emergency thoracotomy. The patient survived his injury and on post-op day two, a holosystolic murmur was noted during physical exam, but he remained hemodynamically stable and intubated. A transthoracic echocardiogram revealed the presence of a ventricular septal defect (VSD), with Doppler flow revealing shunting from the left ventricular cavity into the right ventricular cavity. Ultimately, the clinicians decided upon a trial of extubation with a plan for delayed closure of the VSD. Upon extubation,the patient became hypoxemic with evidence of pulmonary edema; thus, he was re-intubated. The defect was surgically repaired, and the patient had an uneventful recovery thereafter. The purpose of this case report is to present an example of delayed detection of a ventricular septal defect after a penetrating cardiac injury.

Survival following traumatic ventricular rupture and prolonged ambulance transport in a patient with previous coronary artery bypass surgery.

Patients presenting with traumatic cardiac rupture are unlikely to survive lengthy transfers from the trauma scene to a hospital. However, in patients with a previous sternotomy, adhesions may divert cardiac hemorrhage, allowing hemodynamic management to be successful. We present an 83-year-old male with a history of coronary artery bypass grafting (CABG) who sustained a right ventricular rupture. He underwent an immediate redo sternotomy and was discharged 10 days postoperatively with no complications.

[Complex breast reconstruction after severe chest trauma by firearm]. / Reconstruction complexe de la région mammaire après traumatisme thoracique grave par arme à feu.

This case report is of a 47-year-old woman who suffered a ballistic chest trauma with severe left hemothorax and heart wound. She was treated in emergency for the collapse by heart surgery. Then the coverage for her soft thorax tissue loss was done by an ipsilateral musculocutaneous latissimus dorsi pedicled flap. The patient was subsequently addressed to our team for a repair, especially for reconstruction of the left breast. Initially, rehabilitation of aesthetics units breast was achieved through the realization of an abdominal advancement flap, and breast volume was restored by several sessions of lipomodeling. The surgical alternatives were very limited for this post-traumatic complex breast reconstruction. Due to ballistic trauma, no reliable recipient vessels allowed a microsurgical solution, and the ipsilateral latissimus dorsi was used for the coverage. In conclusion, the restoration of the aesthetics units with lipomodeling has achieved a very good result in this extreme thoracomammary region repair.

Multiple Anterior Mitral Valve Perforation After Deep Transfemoral Aortic Valve Implantation.

Transcatheter aortic valve implantation (TAVI) is an alternative for high-risk aortic valve replacement. There are limited data related to the late complications of TAVI. Deep aortic prosthetic valve implantation can cause direct erosive perforation of anterior mitral leaflet or erosive endothelial lesion which predisposes the tissue to infective endocarditis. Our report emphasizes anterior mitral leaflet perforation after TAVI, which may be seen especially in patients exposed to sepsis.