Traumatic transection of the left anterior descending artery caused by a projectile

Coronary lesions caused by penetrating trauma are rare and associated with high mortality rates. Management depends on factors such as the location of the affected vessel and the degree of myocardial dysfunction. We present a case of penetrating cardiac trauma resulting in the subsequent occlusion of the distal left anterior descending artery (LAD) leading to the development of an apical myocardial infarct.

A 21-year-old male was shot with a BB-pellet in the third, left intercostal space, 2 cm lateral to the sternum. The patient proceeded to experience an apical myocardial infarction after an emergent median sternotomy and underwent a catheterization. The mid-LAD was noted to have a thrombus tamponading the site of injury. We opted for conservative management to avoid the possibility of further expanding the suspected perforation. Also, the myocardial area supplied by this vessel was relatively small.

Complex cardiac injuries that include injury to the LAD are associated with higher mortality rates. Our patient had total occlusion of the distal LAD, which caused an uncomplicated apical myocardial infarction. He was successfully managed with conservative medical treatment. Our patient was well at a 2-month follow-up visit and demonstrated further improvement in left ventricular function.