Yeungnam Univ J Med.  2021 Oct;38(4):356-360. 10.12701/yujm.2020.00822.

Cardiopulmonary bypass preparation is mandatory in cardiac exploration for blunt cardiac injury patients: two case reports

• Son SA
• Cho JY
• Kim GJ
• Lee YO
• Jung H
• Oh TH

• KMID: 2521716
• DOI: http://doi.org/10.12701/yujm.2020.00822

Abstract

Treating cardiac injuries following blunt trauma to the chest requires thorough examination, accurate diagnosis, and therapeutic plan. We present two cases; pulmonary vein rupture and left atrial appendage laceration, both as a result of blunt chest trauma. Through these cases, our team learned the importance of maintaining hemodynamic stability during the examination of injured cardiac structures. And based on the comprehensive cardiac examination, a decision to surgically intervene with median sternotomy via cardiopulmonary bypass was made, saving lives of the patient. This report introduces how such decision was made based on what supporting evidence and the diagnostic process leading to the initiation of surgical intervention. This report may help with decision-making process when confronted by blunt cardiac injury patients who need cardiac exploration.

Keyword

Cardiopulmonary bypass; Heart injuries; Multiple trauma

Figure

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  Fig. 1. Initial chest computed tomography (CT) scan of case 1. (A) Initial chest CT scan shows a small amount of hemopericardium (arrow), scanty left hemothorax, and rib fractures. (B) Coronal view of the chest CT scan reveals a small amount of hemopericardium (arrow) and aortic calcifications.

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  Fig. 2. Perioperative findings in case 1. Operative view shows a 2-cm rupture of the left upper pulmonary vein at its junction with the left atrium (arrow). This tear can be revealed in the bloodless field and decompressed heart using cardiopulmonary bypass.

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  Fig. 3. Initial chest computed tomography (CT) scan of case 2. (A) Initial chest CT scan shows scanty hemopericardium (arrow) and right pleural effusion. We suspected right ventricle (RV) injury due to hematoma between the RV and the sternum. (B) Sagittal view of the chest CT scan reveals a small hemopericardium (arrow).

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  Fig. 4. Perioperative findings in case 2. Operative view shows a 1.5-cm rupture of the left atrium appendage (arrow). We repaired the appendage laceration using 4-0 polypropylene suture with polytetrafluoroethylene felt pledget reinforcement, carefully avoiding the left circumflex artery.

Reference

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