Penetrating thoracic trauma producing cardiac shunts

Area of Science:

• Cardiology
• Trauma Surgery
• Thoracic Surgery

Background:

• Cardiac fistulas are rare but serious complications of penetrating thoracic trauma.
• Existing literature reports 101 cases, with this study adding 10 new cases over seven years.

Purpose of the Study:

• To analyze the clinical presentation, fistula types, and management of cardiac fistulas following penetrating thoracic trauma.
• To highlight diagnostic challenges and associations with other cardiac injuries.

Main Methods:

• Retrospective review of 10 patients with cardiac fistulas secondary to penetrating thoracic trauma.
• Analysis of clinical data, diagnostic findings, fistula characteristics, and patient outcomes.

Main Results:

• Ten cases included ventricular septal defects (VSDs), aorta-right ventricular fistulas, and coronary artery-atrial fistulas.
• Four patients were initially asymptomatic despite severe cardiac injury.
• Cardiac murmurs suggestive of fistula were delayed in five of seven hospitalized patients.
• Concomitant traumatic valvular lesions were frequent but often masked by fistula murmurs.
• Ventricular septal defects were the most common fistula type; small VSDs allowed for conservative management and asymptomatic courses.
• Aortic incompetence frequently accompanied aorta-right heart fistulas, leading to congestive heart failure.

Conclusions:

• Cardiac fistulas post-trauma can present insidiously, necessitating vigilant monitoring for delayed murmur detection.
• Ventricular septal defects are the most common type, and conservative management is viable for small defects.
• Aorta-right heart fistulas are associated with aortic incompetence and heart failure, requiring prompt attention.