ABC | Volume 111, Nº3, September 2018

Image Right Ventricular Wound And Complete Mammary Artery Transection Gregorio Laguna, Miriam Blanco, Cristina García-Rico, Yolanda Carrascal Instituto de Ciencias del Corazon (ICICOR), Hospital Clinico Universitario Valladolid, Valladolid - Spain Mailing Address: Gregorio Laguna • Ramon y Cajal Avenue 47003. Valladolid – Espanha E-mail: goyotxmed@hotmail.com Manuscript received April 08, 2018, revised manuscript May 09, 2018, accepted May 09, 2018 Keywords StabWounds/heart; Suicide, Attempted;Heart Injuries/cirurgia. DOI: 10.5935/abc.20180185 Many patients die immediately after suffering a heart wound; on the other hand, many others die before the surgery, during surgery or later, due to complications. 1 We admitted a 33-year-old man after a suicide attempt occurring one hour before, with eleven knife-wounds localized in the left-anterior chest wall (Figure:1-A). Physical exam showed hypotension, dyspnea, high central venous pressure and mild external bleeding. Hemodynamic monitoring, tracheal intubation, vasopressor perfusion, fluid therapy and urgent echocardiogram and tomography were undertaken. ACT showed severe pericardial effusion and moderate left pleural effusion (Figure:1-B, white arrows). Emergency cardiac surgery was performed through median sternotomy. Multiple pericardial tears were visualized. The pericardial clot was removed (Figure:1-C) and the right ventricular wound was closed using a monofilament suture (Figure:1-D, black arrow). In the inner chest wall, a complete left mammary artery transection was observed with severe bleeding into the left pleural cavity (Figure:1-E, white arrow). The mammary artery was repaired, and the bleeding was controlled. The postoperative course was uneventful. Heart wounds are serious health problems. The dramatic statistics have shown that many problems connected with traumatic cardiac lesions are not ultimately resolved. Knife stabs to the right ventricle are perhaps the most common penetrating injury to the heart, but the additional complete transection of the mammary artery is very uncommon. The most important factor for survival is the urgency treatment and the immediate surgical repair. Author contributions Conception and design of the research: Laguna G, Blanco M, García-Rico C, Carrascal Y; Acquisition of data and Analysis and interpretation of the data: Laguna G, García‑Rico C, Carrascal Y; Writing of the manuscript: Laguna G, Blanco M; Critical revision of the manuscript for intellectual content: Laguna G, Blanco M, Carrascal Y. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associatedwith any thesis or dissertationwork. 434