Isolated Injury of the Intrapericardial Pulmonary Vein Following a Blunt Trauma

iDepartment of Cardiovascular Surgery, Shinbeppu Hospital, Oita, Japanj

Hideyuki Tanaka Tatsunori Kimura
A 25-year-old man crashed his car into an electric light pole, and was brought to our hospital. Pericardial effusion inducing cardiac tamponade was detected on computed tomography, but there was no findings suggesting traumatic injuries of any other organs. Since he demonstrated shock during the examination, we performed pericardial drainage following pericardiocentesis to eliminate the cardiac tamponade. After approximately 150ml of blood was drained, his blood pressure increased and stabilized. Blunt cardiac rupture was diagnosed after blood drainage, and midsternotomy was then performed. Percutaneous cardiopulmonary support was established for exploration and confirmation of the injured site. The injured site was confirmed at the junction of the right lower pulmonary vein and right basal pulmonary vein. However, surgical repair under partial circulatory support was impossible because the injury was complicated and hemorrhage was not controllable. Furthermore, there was a risk of air embolization during the process of repair. Therefore, an additional drainage tube was inserted into the superior vena cava, and then the injury was repaired by direct closure under total perfusion using another circulatory circuit with a venous reservoir. No cases of isolated injury of intrapericardial pulmonary vein injury have been reported previously. It was suspected that the development of this injury was related to air bag deployment. This case could be saved by surgical repair under total perfusion using cardiopulmonary bypass.
  Jpn. J. Cardiovasc. Surg. 38:232-234i2009j