Affiliation:
1. St. Ioasaph's Belgorod Regional Clinical Hospital
Abstract
The paper presents a rare case of successful correction of an anterior mitral leaflet perforation. A 28-years old patient was referred with progressive heart failure symptoms at 18 weeks after he had a penetrating stab wound of the right ventricle. Massive pericardial effusion with cardiac tamponade risk and severe mitral valve insufficiency were found at examination. By the time of referral, spontaneous closure of the ventricular septal defect, which is an inevitable component of the “unhappy triad”, had happened. Accurate topical ultrasound diagnosis of the intracardial lesion that resulted from the penetrating wound of the left ventricular outflow allowed for a successful urgent mitral valve reconstruction with a xenopericardial patch and the insertion of a 28 mm MedEng annuloplasty band. To prevent any future pericardial constriction, subtotal pericardectomy by Cooley was performed.Conclusion: Perioperative echocardiography and subsequent follow up by cardiologist are obligatory in all cases of precordial wounds after discharge from hospital. Timely surgery for traumatic mitral leaflet perforation allows for a successful valvuloplasty.
Publisher
Moscow Regional Research and Clinical Institute (MONIKI)
Reference63 articles.
1. Cappelen AH. Vulnus cordis: sutur af hjertet. Norsk Mag Laegevidensk. 1896;11:285–8.
2. Rehn L. Uber penetrirenden herzwunden und herznaht. Arch Klin Chir. 1897;55:315–29.
3. Tang AL, Inaba K, Branco BC, Oliver M, Bukur M, Salim A, Rhee P, Herrold J, Demetriades D. Postdischarge complications after penetrating cardiac injury: a survivable injury with a high postdischarge complication rate. Arch Surg. 2011;146(9):1061–6. doi: 10.1001/archsurg.2011.226.
4. Degiannis E, Loogna P, Doll D, Bonanno F, Bowley DM, Smith MD. Penetrating cardiac injuries: recent experience in South Africa. World J Surg. 2006;30(7):1258–64. doi: 10.1007/s00268-005-0463-5.
5. Kaljusto ML, Skaga NO, Pillgram-Larsen J, Tønnessen T. Survival predictor for penetrating cardiac injury; a 10-year consecutive cohort from a scandinavian trauma center. Scand J Trauma Resusc Emerg Med. 2015;23:41. doi: 10.1186/s13049-015-0125-z.