Penetrating Thoracic Trauma with Undetected Left Ventricular Injury Presenting as Sudden Hypotension during Surgery

Shinya Masuda＊	Kota Itagaki＊	Keisuke Kanda＊＊
Masaharu Hatakeyama＊＊＊	Masaaki Naganuma＊	Nobuaki Suzuki＊
Koichi Nagaya＊

（Department of Cardiovascular Surgery, Aomori Prefectural Central Hospital＊, Aomori, Japan, Department of Cardiovascular Surgery, Sendai Kousei Hospital＊＊, Sendai, Japan, and Department of Cardiovascular Surgery, Aomori City Hospital＊＊＊, Aomori, Japan）

A 55-year-old man was brought to our hospital with a knife penetrating his left anterior chest wall following a suicide attempt. Massive left hemothorax was identified on echocardiography;however, there was no evidence of cardiac tamponade. After draining blood from the left thorax, computed tomography（CT）revealed that the tip of the knife had penetrated the left lung and reached the left pulmonary vein. In preparation for cardiopulmonary bypass, an emergency thoracotomy was scheduled with a plan to access the left lung and left pulmonary vein. The patient was transferred to the operating room, and the procedure was started with the patient in the supine position. During dissection of the femoral vessels, the patient suddenly developed hypotension. After surgical access to the heart was achieved via median sternotomy, a pericardiotomy was performed and cardiopulmonary bypass was established. A 50-mm stab wound was identified at the lateral wall of the left ventricle. The knife was removed, and the left ventricular wound was repaired. The lingular segment of the left lung was partially resected. The patient had no postoperative complications and was transferred to the referral hospital on postoperative day 25. This case report emphasizes the importance of taking appropriate measures for thoracotomy and cardiopulmonary bypass in patients with penetrating thoracic trauma with massive hemothorax, even in the absence of cardiac tamponade on imaging. We were able to successfully manage a life-threatening condition by taking appropriate measures.

 

Jpn. J. Cardiovasc. Surg. 49:72-76（2020）

Keywords：penetrating thoracic trauma;pericardial effusion;cardiac injury of the left ventricle;hemorrhagic shock