Surgical Management of Traumatic Aorta-Right Ventricular Fistula and Aortic Valve Perforation

Case Report

Austin J Trauma Treat. 2015; 2(1): 1006.

Surgical Management of Traumatic Aorta-Right Ventricular Fistula and Aortic Valve Perforation

Daqing Jiang, Zhi-Wei Zhang*, Xuan Jiang and Qu Chen

Department of Cardiovascular Surgery, The First Hospital of China Medical University, China

*Corresponding author: Zhi-Wei Zhang, Department of Cardiovascular Surgery, The First Hospital of China Medical University, 155 Nanjingbei St, Shenyang 110001, China

Received: November 23, 2015; Accepted: December 17, 2015; Published: December 18, 2015

Abstract

A 22-year-old man had attempted to commit suicide using a knife to penetrate the left anterior chest wall. An emergency operation was performed successfully to repair the penetrating cardiac injury on the Right Ventricular Outflow Tract (RVOT) without cardiopulmonary bypass at local hospital. Four years after the operation, he was found of a continuous murmur over chest wall on a routine check-up. Echocardiography revealed aorto-right ventricular fistula in the sinus of Valsalva with moderate aortic regurgitation. In operation, the perforation of the right coronary cusp and the fistula between aorta and right ventricle were identified. The fistula was closed with a Dacron patch and the aortic valve perforation was repaired with autologous pericardium. Long-term follow-up of penetrating thoracic injuries is important for detecting underlying intra-cardiac lesions.

Keywords: Aortic valve insufficiency; Aorto-right ventricular fistula; Chest stab wound

Case Presentation

Penetrating stab wound to the heart not only penetrate the heart but also damage the intracardiac structure such as valves, intraventricular septum, coronary arteries that would affect long-term outcomes of patients [1]. So far, only a few cases of Aorto-Right Ventricular (Ao-RV) fistula with aortic valve injury have been reported in the English literature [2]. Here, we presented a case with Ao-RV fistula and aortic valve insufficiency 4 years following the initial surgery.

A 22-year-old man had attempted to commit suicide using a knife to penetrate the anterior chest wall 4 years ago. On arrival at the emergency room in a local hospital, he was in shock, with cardiac tamponade and a large left-sided hemothorax (Figure 1). An emergency operation was performed to repair the penetrating cardiac injury. The wound on the surface of the Right Ventricular Outflow Tract (RVOT) was successfully repaired without cardiopulmonary bypass. The postoperative course was uneventful and he was discharged without further checkup or being followed up. Four years after the initial operation, a continuous murmur was heard at the third intercostal space on a routine check-up 2 months before admission. Chest X-ray showed slightly increased pulmonary blood flow and cardiomegaly. ECG showed left ventricular hypertrophy with normal sinus rhythm.