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Coronary artery fistula coexisting with a ventricular septal defect due to a penetrating gunshot wound
T Kwan1, L Salciccioli, A Elsakr
1Department of Medicine, State University of New York, Brooklyn 11203, USA.
Insights
A gunshot wound survivor developed a rare combination of coronary artery fistula and ventricular septal defect. This case highlights the natural history of these combined cardiac injuries without surgical intervention.
Area of Science:
- Cardiovascular Surgery
- Trauma Surgery
- Interventional Cardiology
Background:
- Penetrating cardiac injuries, such as gunshot wounds to the chest, can lead to complex cardiac sequelae.
- Coronary artery fistulas and ventricular septal defects are individually recognized cardiac abnormalities.
- The simultaneous occurrence of these two conditions following penetrating cardiac trauma is exceedingly rare.
Observation:
- A patient presented with a penetrating gunshot wound to the chest.
- Cardiac investigations, including echocardiography and cardiac catheterization, identified a coexisting coronary artery fistula and a ventricular septal defect.
- The left-to-right shunt associated with these defects persisted at a 15-month follow-up.
Findings:
- This report details the first documented case of combined coronary artery fistula and ventricular septal defect resulting from penetrating cardiac injury.
- The findings demonstrate the natural history and persistence of a left-to-right shunt in this rare combined injury without surgical correction.
- Echocardiography proved effective in monitoring the progression of the cardiac defects.
Implications:
- This case expands the understanding of potential cardiac complications following chest trauma.
- It underscores the importance of thorough cardiac evaluation in survivors of penetrating chest injuries.
- The natural history observed provides valuable insights for future management strategies for similar rare combined cardiac injuries.
Abstract:
We describe a patient who survived a penetrating gunshot wound to the chest. Cardiac evaluation including echocardiography and cardiac catheterization revealed a coronary artery fistula and a ventricular septal defect. This combination has been rarely reported in patients with penetrating cardiac injury. Follow-up echocardiography performed 15 mo later showed persistent left-to-right shunt. This is the first case in the literature demonstrating the natural history of combined coronary artery fistula and ventricular septal defect without surgical correction.