The lifesaving effects of cardiac adhesions

Abstract

Patients that incur myocardial disruption from penetrating cardiac injuries have an average 6%-10% expectancy rate of reaching the hospital alive. If prompt recognition on arrival is not immediate, the morbidity and mortality are significantly higher due to the secondary physiologic sequalae of either cardiogenic or hemorrhagic shock. Even after a triumphant arrival at a medical facility, out of that 6%-10%, half of those patients are not expected to survive. The unique significance of the presenting case breaks this tradition, expanding past the paradigms and issuing an exceptional understanding of the protective effects that cardiac surgery can futuristically cause through preformed adhesions. In our case, the cardiac adhesions achieved this by containing a penetrating cardiac injury that had caused complete ventricular disruption.

Keywords: Cardiac surgery; Cardiothoracic imaging; Diagnostic radiology; Emergency radiology; Pericardial adhesions; Ventricular pseudoaneurysm.

Fig. 1

Sagittal Chest CT emphasizing the penetrating trajectory of the knife, coursing posteriorly above the left fifth rib and through the anterior wall of the left ventricle (LV). The penetrating wound traveling from the anterior chest wall to the left ventricle measured 10 cm in length. The large ventricular pseudoaneurysm (PSA) communicates with the left ventricle (LV).

Fig. 2

Axial MIP Chest CT identifying the communicating defect of the contained pseudoaneurysm (PSA) involving the right ventricle (RV) and left ventricle (LV). The violation to the right ventricle measured roughly 0.7 × 0.5 × 0.2 cm and an estimated 0.7 × 1.1 × 0.2 cm defect at the left wall. The body of the pseudoaneurysm measured 6.7 × 3.1 × 3.5 cm.

Fig. 3

Transthoracic apical 4-chamber echocardiogram with color Doppler flow across the anterior right and left ventricular walls, centering over the interventricular septum and emptying into the ventricular pseudoaneurysm (PSA).