Traumatic Laceration of the Posterior Left Ventricle Diagnosed by Transesophageal Echocardiography
A 49-year-old man presented with a stab wound to the left chest. On physical examination, he had jugular venous distention and distant heart sounds; a trauma ultrasound showed a large pericardial effusion. Emergency thoracotomy revealed a large amount of blood and clot in the pericardial space and rapid hemorrhage from a laceration of the right ventricular free wall that was repaired with sutures. A transthoracic echocardiogram the next day revealed a large muscular ventricular septal defect. A follow-up transesophageal echocardiogram confirmed the presence of a muscular ventricular septal defect (Figure 1 and Movie I in the online-only Data Supplement), but it also surprisingly demonstrated a nearly full-thickness laceration of the posterior wall of the left ventricle (Figure 2 and Movie II in the online-only Data Supplement). The injuries were seen aligned along the trajectory of the stab wound (Figure 3). The ventricular septal defect and posterior left ventricle laceration were both managed conservatively, and the remainder of the patient's hospital course was uneventful.
Penetrating cardiac trauma has a high mortality due to tamponade or exsanguination.1 Although right ventricular lacerations and ventricular septal defects are well-described complications of stab wounds, posterior left ventricle lacerations are usually diagnosed at autopsy.2 Diagnosis has important clinical consequences, because this defect can be repaired surgically with placement of sutures or fibrin glue.3 These findings suggest that transesophageal echocardiogram should be performed in all survivors of penetrating cardiac trauma to guide initial treatment and diagnose previously unrecognized complications.4
The online-only Data Supplement is available with this article at http://circ.ahajournals.org/cgi/content/full/123/24/e634/DC1.
- © 2011 American Heart Association, Inc.
- Rossi MA,
- Alvarenga DG,
- Agrizzi RS
- Toda K,
- Yoshitatsu M,
- Izutani H,
- Ihara K