Myocardial infarction following repair of a ruptured heart.

Penetrating chest trauma can lead to the cardiac rupture and coronary artery damage, which causes a high mortality rate (1). Most of the patients with penetrating cardiac trauma die at the scene of the accident (1). Coronary artery (CA) injuries are rare but highly lethal (2). Also, CA injury may occur during repair of a ruptured heart as in our reported case.

CLINICAL FEATURE

The patient was a 40‐year‐old man who suffered from penetrating heart trauma two days before being referred to us. He had undergone repair of tearing at a hospital outside the city. He was still complaining of chest pain. Q‐wave and ST elevation in v1‐v3 were seen. He was referred with suspicion of damage to left anterior descending artery (LADA).

Vital signs were stable. Echocardiography revealed anteroseptal akinesia with left ventricular ejection fraction (LVEF)30%. In angiography, LADA was cutoff at mid‐part. Any attempt at angioplasty was unsuccessful(Figure 1). Assuming the artery was ligated during repair and due to the fact the patient was stable, we decided to follow him, so discharged him in good condition after three weeks.

FIGURE 1

Coronary angiography at admission day; angioplasty by crossing a 0.014″ wire was failed.

Two months later, he complained of chest pain. Echocardiography revealed LVEF 50%. According to angiography (Figure 2), he became a candidate for bypass surgery. The surgeon had reported ligation of LADA by some sutures during previous repair. After a week, he was discharged in good condition.

FIGURE 2

Coronary angiography after 2 months; LADA had good distal run‐off after previous site of occlusion.

DISCUSSION

Penetrating chest trauma can lead to cardiac rupture. LADA is the most commonly injured artery. Heart injury might be complex, even in follow‐up. Any emergency repair might have consequences, such as ligating of an artery, especially in non‐equipped facilities.

CONFLICT OF INTEREST

None declared.

AUTHOR CONTRIBUTIONS

Zh. T. is the corresponding author. H. V. and Zh. T. diagnosed and followed the patient and conceived of the case report, and took full responsibility for the contents of this manuscript.