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The Journal of Cardiovascular Surgery 1999 June;40(3):425-7

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

Multivascular trauma on an adolescent. Perioperative management

Asteri Th., Missias G.*, Tsagaropoulou I., Sarigiannis G., Mikoniou G.*, Ekonomidis A.*, Fessatidis I.*, Papavassiliou H., Spyrou P.*

From the Department of Cardiac Anaesthesia * Cardiac Surgery Center of Northern Greece “G. Papanikoulao” Hospital, Exohi, Thessaloniki, Greece


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Pen­e­trating vas­cular ­injury, in par­tic­ular at the ­neck, is a ­life-threat­ening ­trauma not ­only of the ­nature and the ana­tomic prox­imity of car­di­o­vas­cular, aero­di­ges­tive, glan­dular and neu­ro­logic ­system but ­also of the devel­op­ment of ­early and ­late com­pli­ca­tions. The fol­lowing ­case ­report ­describes our expe­ri­ence ­with a pen­e­trating ­wound ­patient, who was ­admitted to our emer­gen­cies ­twelve ­hours ­after the acci­dent. The ­only demon­strable objec­tive ­signs ­included a ­large ­hematoma at the ­right-­side of the ­neck and dis­tended med­i­as­tinum on the ­chest X-ray. As the ­patient was car­di­o­vas­cu­larly ­unstable he was imme­di­ately trans­ported to the the­ater ­without any angio­graphy. The man­da­tory oper­a­tive explo­ra­tion was ­initially unsuc­cessful and a ­median ster­notomy ­with a stan­dard car­di­o­pul­mo­nary ­bypass and ­deep hypo­thermia cir­cu­la­tory ­arrest was estab­lished to ­restore all the vas­cular ­lesions. Actu­ally, the ­patient was in crit­ical con­di­tion ­with a rup­ture of the ­right ­internal jug­ular ­vein, a ­large pseu­do­aneu­rysm of the innom­i­nate ­artery and an avul­sion of the ­ascending ­aorta ­with the sus­pi­cion of a car­diac tam­po­nade. The post­op­er­a­tive ­period ­lasted two ­full ­months, ­while com­pli­ca­tions ­appeared. The sub­stan­tial mes­sage ­from ­this ­multivas­cular ­trauma is the ­early diag­nosis of the ­life-threat­ening com­pli­ca­tions as exsan­gui­na­tions, ven­tric­ular fib­ril­la­tion and the ­ability to min­i­mize post­op­er­a­tive com­pli­ca­tions, ­which ­will ­impair the ­normal func­tional ­life of the ­patient.

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