心血管疾患と診断

Traumatic Pseudoaneurysm of Left Anterior Descending Artery Caused by Thoracic Stab Wound Treated with Coil

Abstract

Ata Firozi, Omid Shafee, Aliasghar Farsavian, Hamidreza Sanati, Farshad Shakerian, Reza Kiani, Ali Zahedmehr, Mona Heidarali

Trauma is one of the most common causes of death worldwide. Penetrating cardiac injury (PCI) is highly lethal and represents an increasingly important form of traumatic injury. We describe a 25 year-old man suffered stab wound and PCI, as a result of which he underwent surgical thoracotomy for tamponade. He was discharged in good clinical condition and no cardiac perforation was detected. Two weeks later, he presented to our center with prolonged chest pain. Electrocardiography (ECG) and cardiac biomarkers confirmed myocardial damage. Echocardiography showed hypokinesia and thinning (0.6 mm) of the inferoapical wall segment and mildly reduced left ventricular systolic function. Angiography revealed patent left main coronary artery, LAD, left circumflex, and right coronary artery, along with an abnormal aneurysmal structure at the distal part of the LAD. Coil embolization of the distal LAD pseudoaneurysm was performed which was placed to occlude the proximal entry site of the pseudoaneurysm. Angiography confirmed the disappearance of the pseudoaneurysm. The patient was discharged after 48 hours. Follow-up angiography after two months showed no residual leakage across the vessel. Coil embolization of a distal coronary pseudoaneurysm can be performed as an alternative procedure instead of surgical ligation of the small vessels, with good results. It should be emphasized that one should occlude both proximal and distal entry sites to avoid blood leakage.