Rv nail injury
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A 22-year-old construction worker sustained a nail gun injury that caused a 5-cm nail to penetrate his right ventricle. An CT scan showed the nail in the right ventricle as well as a blood clot in the pulmonary artery. The patient was taken urgently to surgery where the nail was removed and the ventricle repaired. During surgery, a 3-cm blood clot was also removed from the right ventricular outflow tract. The patient was successfully weaned from bypass and had an uneventful recovery.
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- 1. c 2010 Wiley Periodicals, Inc. 179 Penetrating Nail Injury to the Right Ventricle Associated with Thrombus Formation Mohammad Shihata, M.D. and Nitin Ghorpade, M.D. Division of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada doi: 10.1111/j.1540-8191.2009.00976.x (J Card Surg 2010;25:179) A 22-year old construction worker sustained an ac-cidental nail gun injury to the anterior chest wall. An enhanced chest computerized tomography showed a 5-cm nail penetrating the right ventricle. There was a filling defect in the proximal pulmonary artery suspi-cious of a clot (Fig. 1). The patient was urgently trans- Address of correspondence: Mohammad Shihata, 3H2.17WMC, 8440- 112 Street, The Division of Cardiac Surgery, University of Alberta, Ed-monton, Alberta, Canada, 3H2.17 T6G 2B7. Fax: (780) 6282575; e-mail: mshihata@gmail.com ferred to the operating room. Cardiopulmonary bypass (CPB) was instituted through the right femoral ves-sels followed by median sternotomy. The nail was ex-tracted as the sternum was retracted. There was min-imal bleeding from the decompressed right ventricle and the defect was closed primarily with a pledgeted monofilament suture. A right atriotomy and pulmonary arteriotomy were performed after bicaval cannulation to explore the right ventricle. A 3-cm clot was removed from the right ventricular outflow tract. The patient was weaned successfully from CPB and had uneventful re-covery. Figure 1. Enhanced chest computerized tomography demonstrating a nail penetrating the right ventricle and a filling defect (clot) in the right ventricular outflow tract. PA = pulmonary artery; RV = right ventricle; RVOT = right ventricular outflow tract; LV = left ventricle.