Rare Case of Survival after Left Ventricular Traumatic Laceration due to Pseudoaneurysm
Krish C. Dewan, Lindsay Volk, Antonio Chiricolo, Mark Russo.
Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
OBJECTIVE: Posttraumatic left ventricular pseudoaneurysms are rare but often fatal. Few case reports describe delayed presentation. We present the a rare case of the development of an acute pseudoaneurysm following penetrating left ventricular trauma.
METHODS: A 60-year-old female with a prior history of CABG presented after two 2 cm self-inflicted stab wounds to the cardiac box. Computed tomography imaging revealed a left ventricular perforation with pseudoaneurysm (Figure 1). The patient was taken to the operating room where she was placed on cardiopulmonary bypass via a femoral approach. After a redo sternotomy was performed, bypass was converted to central cannulation and the left ventricular defect was identified adjacent to the distal LAD. Care was taken to avoid injury to the LAD when the defect was repaired with 4-0 pledgeted prolene suture. The patient tolerated the procedure well and had no lasting cardiac complications.
RESULTS: This patient likely developed a pseudoaneurysm secondary to the scar tissue from her prior sternotomy from her CABG allowing containment of the left ventricular laceration. Penetrating cardiac trauma has a fatality rate approaching 80-90% and it is likely that this patientís prior scar tissue allowing the pseudoaneurysm formation was a main contributor to her survival. The temporizing effect of the pseudoaneurysm allowed survival to the operating room where definitive repair was accomplished.
CONCLUSIONS: There have been few case reports of delayed pseudoaneurysms that present years following the initial penetrating trauma. This represents the first case in the literature of an acute pseudoaneurysm facilitating survival in penetrating trauma.
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