Delayed Pericardial Tamponade, Mitral Insufficiency and VSD after Stab Wound to the Heart

Case Report

A 25-year-old male self inflicted a wound to his left hemithorax and subsequently presented in a hemodynamically stable condition to the emergency unit of our department. On admission, an echocardiography evaluation showed a small, not relevant pericardial effusion. On physical examination, no murmur was detectable. Hence, no operation was planned. The patient was transferred to the intensive care unit. On awaking several hours later, the patient became agitated, fought the respirator and thus performed a Valsalva maneuver. His hemodynamic condition worsened rapidly and he had to be resuscitated. After transferring the patient to the operating room, a lesion at the pulmonary artery was identified as the reason for the pericardial effusion. The lesion was closed with a running suture. The following day, an operative revision of a hematothorax was performed. Two weeks later, a pericardiocenthesis was performed. During this period, serial echocardiographic investigation showed no abnormalities. The patient recovered after developing a pulmonary embolism due to a deep venous thrombosis and was transferred to another hospital. Two months later the patient gradually developed tachycardia and congestive heart failure. At reevaluation, echocardiography demonstrated a mitral insufficiency (MI) II+ and a ventral septal defect (VSD) with a relevant shunt volume. During operation, the VSD was identified and closed using single mattresses sutures. A cleft in the anterior mitral leaflet and the mitral annulus ([Fig. 1]) was closed, using three pericardial reinforced mattresses sutures. The postoperative course was uneventful and the control echocardiograph showed no residual VSD or mitral insufficiency.

Fig. 1 Intraoperative finding.

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